The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


John Davies, Michael A. Gentile, Janice J. Thalman, Neil R. MacIntyre; Duke Medical Center, Durham, NC

Background: At the present time, inhaled nitric oxide (iNO) is only FDA approved for primary pulmonary hypertension of the newborn. However, iNO is frequently used "off label" to reduce pulmonary hypertension and right ventricular afterload in many adult cardiothoracic patients following surgery. Unfortunately, this off label use of iNO comes with an exorbitant price tag that respiratory departments often must finance. Aerosolized Iloprost, a potent pulmonary vasodilator, is now FDA approved for the specific treatment of pulmonary hypertension. The purpose of this study was to determine if Iloprost can potentially be a viable alternative to iNO in post cardiothoracic surgery patients. Methods: After Iloprost delivery guidelines were established, an IRB approved retrospective review was done in patients who were switched from iNO to Iloprost for a period of 16 months (10/2009 - 3/2011). The patients received 10mcg treatments of aerosolized Iloprost using a vibrating mesh nebulizer (Aeroneb Solo, Aerogen Ltd., Galway, Ireland). The end points were; 1) tolerance to Iloprost and 2) whether or not patients had to be switched back to iNO by the cardiothoracic ICU team. Results: A total of 64 patients post cardiothoracic surgery were switched over to Iloprost from iNO. The patient populations consisted of lung transplants (19), coronary artery bypass grafting and/or valve replacement (18), ventricular assist device placement (12), heart transplant (6), pulmonary thromboendarterectomy (3) and other procedures (6). Of the 64 patients, 58 tolerated Iloprost and met clinical goals. Six were returned (9%) to iNO therapy (3 lung transplants, 1 heart transplant, 1 ventricular assist device implant and 1 coronary artery bypass grafting). 1 patient received both iNO and Iloprost concomitantly. There were no untoward effects from the delivery of Iloprost in any patient. Conclusion: In this patient population aerosolized Iloprost appeared to be safe and was an effective alternative to iNO for controlling pulmonary artery pressures and reducing right ventricular afterload.
Sponsored Research - Aerogen supplied 2 nebulizers