2001 OPEN FORUM Abstracts
THE USE OFINHALED PROSTACYCLIN FOR SELECTIVE REDUCTION OF PULMONARY ARTERY PRESSURES:PILOT DATA
Brian K. Walsh, BS, RRT; Allan Doctor,MD; Patricia Ann Doorley, MS, RRT; Stewart Lowson, MD; University of VirginiaHealth System; Charlottesville, Virginia.
Background Following the FDA?sapproval for the use of Inhaled Nitric Oxide (INO) in the neonate, the costfor the daily administration of INO was set by INO Therapeutics at $3000 perday. The cost of administration of this therapeutic agent has forced many cliniciansto seriously consider both the indications for administering INO and the useof possible alternative, and less expensive, agents to selectively decreasepulmonary artery pressures (PAP). We have undertaken a clinical study to explorethe use of inhaled prostacyclin as an alternative to INO in the management ofchildren and adults with acute pulmonary hypertension complicating their clinicalcourse.
Methods Inhaled prostacyclinwas administered to five patients with elevated pulmonary artery pressures either(1) during pre-operative catheterization to determine operative risk and potentialuse as a post-surgical intervention or (2) following the operative procedureto improve right heart function and cardiac index. The inhaled prostacyclinwas administered through the inspiratory limb of the ventilator circuit viacontinuous nebulization, using a MiniHeartR Nebulizer (Westmed, INC.)with the flow rate set at 2 Lpm and a Protégé 3010 Syringe Infusion PumpR(Medex) set at an infusion rate of 8 ml/hr when needed. The inhaled prostacylindose was initiated at 50 ng/kg/min and then weaned as tolerated. Prior to, andduring drug delivery, hemodynamic and respiratory variables were recorded andblood was drawn for ABG analysis and platelet aggregation studies.
|Age||Diagnosis/Procedure||Use of Inhaled Prostacylin||Mean PAP (% s)|
|5 mo||Pulmonary Stenosis/Cardiac Cath||Cardiac Cath||17|
|25 yo||Tetralogy of Fallot and PulmonaryAtresia/Cardiac Cath||Cardiac Cath||7|
|3 yo||VSD patch leak/Repair||Pre- and Post Op||19|
|63 yo||Severe MR/MV and AV replacement||Peri- and Post Op||40 - 50|
|35 yo||Rheumatic Mitral Stenosis/MVreplacement||Peri- and Post Op||31|
Conclusion The average dailycost for the administration of 50 ng/kg/min of inhaled prostacylin to a 70 kgadult is approximately $215. Therefore, inhaled prostacyclin bears further studyas a selective pulmonary vasodilator and cost effective therapeutic agent forthe acute management of elevated pulmonary artery pressures.