Conference: 2011 PH Professional Network Symposium
Release Date: 09.22.2011
Presentation Type: Abstracts
M. Wilson, ACNP-BC, MSN, BSN, BSESS and J. Tarver, MD
Orlando Heart Center, Orlando, FL
PURPOSE: Inhaled treprostinil (Tyvaso) is approved for the treatment of pulmonary arterial hypertension (PAH) World Health Organization (WHO) FC III. This is a case report of the protocol used to in a patient requiring transition from Tyvaso to IV treprostinil (Remodulin) due to clinical deterioration and impending surgery.
METHODS: A 56y/o female with Scleroderma associated PAH receiving inhaled treprostinil.
RESULTS: The transition took place over 8 days with intravenous treprostinil dosing based on improvement in dyspnea, CO, and CI. The patient was transferred to the cardiac intensive care unit (CICU) for hemodynamic monitoring on day 8. The CICU also had nurses who undergone the same training as the PCU nurses and had to meet the same minimum criteria to be able to care for patients with PH and had an additional ICU lecture focusing on hemodynamic changes in patients with PAH. The final dose of IV treprostinil was 17ng/kg/min. The patient experienced hemodynamic improvement as evidenced by increase in CI from 1.55 to 3.8 and resolution of dyspnea. The patient did not need any anti-diarrhea medication and after 2 doses of Ondansetron decline anti-emetic and did not experience nausea or diarrhea.
CONCLUSIONS: This case study describes a protocol that has the ability to quickly and safely transition a progressive PAH patient from inhaled treprostinil to IV treprostinil with improvement in hemodynamics, allowing the patient to successfully undergo abdominal surgery for removal of a colonic mass.
CLINICAL IMPLICATIONS: Regular monitoring of PAH patients allows for detection of stability or deterioration and subsequent therapy change as indicated. Surgical procedures are inherently high risk in patients with PAH, particularly those with poor functional capacity or adverse hemodynamics. The initiation of infused treprostinil, and the rapid up-titration to therapeutic doses based on hemodynamic and clinical factors allowed the successful completion of a necessary surgery in this patient and may serve as a model for patients who face this scenario in the future.
DISCLOSURES: Both Melisa Wilson and James H. Tarver, M.D. are part of the United Therapeutics Speaker Bureau