The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

A RETROSPECTIVE LOOK AT THE RESPONSE OF PATIENTS TO INHALED EPOPROSTENOL(FLOLAN) NEBULIZED WITH AN AERONEB SOLO AS COMPARED TO NITRIC OXIDE.

Tim France; Respiratory Care, Sentara, Norfolk, VA

Background: Inhaled Flolan is a drug modality that has recently become more attractive as an alternative to Nitric Oxide for the treatment of pulmonary hypertension and refractory hypoxemia. In an effort to offset the prohibitive cost of Nitric Oxide institutions have been using inhaled Flolan as a substitute. Most results have shown that inhaled Flolan is at least equivalent to Nitric Oxide in decreasing mean pulmonary artery pressure (MPAP). We started using inhaled Flolan in our refractory hypoxia patients first, subsequently branching out to our cardiac surgery population. We hypothesized that inhaled Flolan would be at least equal to Nitric Oxide in 1) decreasing pulmonary artery pressures and 2) improving Pao2/Fio2 (P/f) ratios. Method: Inhaled Flolan was initiated in the cardiac operating room at a dose of 50 ng/kg/min for increased MPAP after resumption of normal circulation in post cardiac surgery patients. Also, Flolan was used to increase p/f ratios in our refractory hypoxemia patients. Flolan was delivered to an Aeroneb solo vibrating mesh nebulizer via a Bbraun syringe pump. As the patient’s condition improved Flolan was weaned down in increments of 10 ng/kg/min. Flolan results were compared to a patient population that received Nitric Oxide the year before. Results: When results are compared between Flolan and Nitric Oxide there is no significant difference in P/f improvement and virtually no difference between the two drugs when comparing MPAP improvement. P/f improved on average by 124% with NO and 98% with Flolan. MPAP decreased on average by 29% with NO and 31% with Flolan. Average cost for NO was $2428/day and for Flolan cost were $211/day. Conclusion: Inhaled Flolan appears to be at least as effective as Nitric Oxide when used to decrease MPAP or to increase P/f ratio in refractory hypoxemia. With the decrease in cost, inhaled Flolan seems to be an attractive alternative to Nitric Oxide. Sponsored Research - None NO vs Flolan Comparison