The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Raymond B. Malloy, Brian Glynn; Pulmonary Care, Thomas Jefferson University Hospital, Philadelphia, PA

Effects on Mortality Rates Utilizing Aerosolized Epoprostenol and Inhaled Nitric Oxide (INO) For the Treatment of Hypoxemic Patients. Malloy R, Glynn B, McClintic C, Pezzano T, Weibel S. BACKGROUND: Both aerosolized Epoprostenol and Inhaled Nitric Oxide (INO) are used to treat hypoxemic patients (ARDS and /or Pulmonary Hypertension). Neither is FDA approved for this use though it is the standard of care in many critical care units. At Thomas Jefferson University Hospital, Philadelphia, Pa., we compared the outcomes for two methods of treatment of hypoxemia. METHODS: In 2008, 22 adult patients with a diagnosis of refractory hypoxemia with a non-cardiac history were given INO at 40 parts per million (PPM) through a breathing circuit on a PB 840 Ventilator and treated by INO pathway. An evidence based literature search was conducted and INO therapy for non-cardiac patients with refractory hypoxemia was discontinued and an aerosolized Epoprostenol pathway was approved for critical care patients with hypoxemia. In 2009, 30 non-cardiac adult patients with refractory hypoxemia were treated with aerosolized Epoprostenol via continuous nebulizer. We also examined the pao2/fio2 ratio in all patients prior to initiation of therapy as an indicator of severity of pulmonary compromise. RESULTS: Our findings are consistent with current literature with 95% of the patients expired prior to discharge with a survival of 5% when treated with INO (n=22). 73% of the patients expired prior to discharge with a 27% survival rate when treated with aerosolized Epoprostenol (n= 30). Chi square p < .05 (n=52). The median pao2/fio2 ratio was 71 for the INO group and 82 for the Epoprostenol group. CONCLUSION: The comparison showed a clinically significant reduction in mortality rates with patients treated with aerosolized Epoprostenol in lieu of INO and similar median oxygen indices. There is also a significant cost savings in substituting aerosolized Epoprostenol for INO. The cost of providing INO was $8000.00 per patient versus $1,600.00 for the Epoprostenol population resulting in an 80% reduction in costs. Further investigative studies are required to validate the clinical findings. Sponsored Research - None