2006 OPEN FORUM Abstracts
Peri-Operative Administration of Aerosolized Prostacyclin via Face Mask and Endotracheal Intubation in a Patient with Severe Pulmonary Hypertension
Siobal BS RRT, Robin Stackhouse MD, Jean-Francois Pittet MD, Julin Tang MD MS,
Department of Anesthesia,
Introduction: Aerosolized prostacyclin (AP) can be an effective treatment for pulmonary hypertension (PH) in the acute care setiing.1 AP selectively dilates pulmonary vasculature, reduces pulmonary arterial pressure (PAP), decreases pulmonary vascular resistance and afterload to the right ventricle (RV). In the peri-operative setting, AP can be effective in preventing RV failure.
Case Summary: A 61 year old female admitted for shortness of breath and pneumonia was found to have large bilateral ovarian tumors and scheduled for an exploratory laparatomy. The patient's pre-operative workup was significant for severe COPD and cor pulmonale with baseline ABG 7.42, 53, 48, 28.0, 9.3 , FEV1 = 25%, FEF 25/75 = 5%, DLCO = 20% of predicted; and severe PH with reduced RV systolic function and an estimated systolic PAP of 75 mmHg by transthoracic echocardiogram. During pre-op assessment, the anesthetic plan was to administer aerosolized prostacyclin intra-operatively to prevent worsening RV function. In the operating room prior to intubation and general anesthesia, a pulmonary artery catheter (Edwards Lifesciences,
Discussion: This case report demonstrates the effectiveness of utilizing this delivery system for aerosolized prostacyclin2 by face mask and by endotracheal intubation during the peri-operative period in a patient with significant RV dysfunction. Inhalation of the alkaline aerosol (approximate pH of 10.5)2 did not cause bronchospasm in this patient with chronic airway obstruction. We conclude that AP can be an effective treatment in high risk patients with severe PH and RV dysfunction in the acute care, critical care, and intra‑operative setting.
|PAP (mean) mmHg||Pre AP 60/33 (41)||Post AP 42/28 (33)||IntraOp AP 43/28 (33)*||ICU AP 42/25 (31)*||PostExtub AP 43/24 (30)||AP Off 64/33 (43)*|
|CCO L/min||2.3||4.7||5.5 *||5.2*||5.8||6.2*|
|RV EF %||10||22||---||24*||20||21*|
* average of several recorded measurements
1. Siobal MS. Aerosolized Prostacyclins. Resp Care 2004;49(6): 640-652.
2. Siobal MS, Kallet RH, Pittet JF, Warnecke EL, Kraemer RW, Venkayya RV, Tang JF. Description and evaluation of a delivery system for aerosolized prostacyclin Resp Care 2003;48(8):742-753.