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Transition from Inhaled Nitric Oxide to Nebulized Room Temperature Stable Epoprostanol for Treatment of Acute Pulmonary Hypertension in the Intensive Care Unit of a University Hospital

A. Syed

Katie Muzevich


C. Jarrin

L. Harrison

Daniel Grinnan


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Syed A, Muzevich K, Jarrin C, Harrison L, and Grinnan D

Virginia Commonwealth University; Richmond, VA; United States of America

BACKGROUNDWhile inhaled nitric oxide is only approved by the FDA for treatment of pulmonary hypertension of the newborn, its ‘off-label’ use in the intensive care units (ICU) of major hospitals throughout the United States is widespread. It is commonly used to manage acute pulmonary hypertension associated with acute respiratory distress syndrome or sickle cell anemia, as well as to prevent right ventricular failure in patients following cardiac surgery. Despite its extreme cost, inhaled nitric oxide remains widely used because of its relative safety, ease of administration, and perceived efficacy. We herein describe a novel method of administering inhaled room temperature stable epoprostanol (RTS epo) in our ICUs, and the process of this institutional change.

METHODS: Using a standard Alaris infusion pump, RTS epo is prepared using a 50mg bottle in a 30,000ng/ml concentration and starting at a dose of 50ng/kg/min. Dedicated infusion pumps have been programmed by pharmacy and are labeled to prevent error. Order caresets have been established in our electronic medical record to ensure that dosage and titration are specific and correct. This careset includes parameters for medication titration. Using an Aeroneb Solo Nebulizer in-line with the ventilator, medication is continuously infused through the inspiratory arm of the ventilator circuit. Respiratory therapists working in the ICU have been in-serviced on Alaris pump operation and operation of the single use nebulizer. All providers involved in the care of patients receiving nebulized RTS epo, including anesthesiology, cardiac surgery, and intensivists, have been in-serviced on the details of this protocol. We have obtained institutional IRB approval to study the efficacy of nebulized RTS epo, as measured by both clinical outcomes and changes in hemodynamics. We have also developed a tool to assess the provider experience with nebulized RTS epo, in comparison to inhaled nitric oxide.

CONCLUSIONS: We report our method of using nebulized RTS epo in the management of acute pulmonary hypertension and acute RV failure in our ICU population. Having instituted this change, we propose to prospectively evaluate the efficacy of inhaled RTS epo in our ICU, as well as the ease of administration and cost savings.