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Nasrullah A, Virk S, Shah A, Jacobs M, Hamza A, Sheikh AB, Javed A, Butt MA, Sangli S. Acute Respiratory Distress Syndrome and the Use of Inhaled Pulmonary Vasodilators in the COVID-19 Era: A Narrative Review. Life (Basel) 2022; 12:1766. [PMID: 36362921 PMCID: PMC9695622 DOI: 10.3390/life12111766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 09/03/2023] Open
Abstract
The Coronavirus disease (COVID-19) pandemic of 2019 has resulted in significant morbidity and mortality, especially from severe acute respiratory distress syndrome (ARDS). As of September 2022, more than 6.5 million patients have died globally, and up to 5% required intensive care unit treatment. COVID-19-associated ARDS (CARDS) differs from the typical ARDS due to distinct pathology involving the pulmonary vasculature endothelium, resulting in diffuse thrombi in the pulmonary circulation and impaired gas exchange. The National Institute of Health and the Society of Critical Care Medicine recommend lung-protective ventilation, prone ventilation, and neuromuscular blockade as needed. Further, a trial of pulmonary vasodilators is suggested for those who develop refractory hypoxemia. A review of the prior literature on inhaled pulmonary vasodilators in ARDS suggests only a transient improvement in oxygenation, with no mortality benefit. This narrative review aims to highlight the fundamental principles in ARDS management, delineate the fundamental differences between CARDS and ARDS, and describe the comprehensive use of inhaled pulmonary vasodilators. In addition, with the differing pathophysiology of CARDS from the typical ARDS, we sought to evaluate the current evidence regarding the use of inhaled pulmonary vasodilators in CARDS.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Max Jacobs
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Amina Hamza
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Muhammad Ali Butt
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15512, USA
| | - Swathi Sangli
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA 15212, USA
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Küçükoğlu MS, Hanta İ, Akdeniz B, Güllülü S, Atahan E, Sayın T, Okumuş G, Önen ZP, Yokuşoğlu M, Baygül A. Clinical efficacy, safety, tolerability, and survival outcome of long-term inhaled iloprost treatment in the management of pulmonary arterial hypertension: Data from prospective multicenter observational OPTION study. Anatol J Cardiol 2021; 25:721-732. [PMID: 34622787 PMCID: PMC8504660 DOI: 10.5152/anatoljcardiol.2021.03009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate clinical efficacy, safety and tolerability of long-term inhaled iloprost treatment in the daily practice for the management of pulmonary arterial hypertension (PAH). METHODS A total of 115 patients with PAH on inhaled iloprost treatment were included. New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and 6-minute walk distance (6MWD) were recorded at baseline and at 3rd to 24th month visits. Safety and tolerability of iloprost treatment were also evaluated during follow-up, as were the survival, clinical worsening, and the related risk factors. RESULTS The treatment was associated with an increase in the percentage NYHA functional class II (from 0.0% at enrolment to 36.2% at 24th month visit) patients but no significant difference was noted in 6MWD values. Clinical worsening was observed in 63.5% patients, while survival rate was 69.6%. NT-proBNP levels were significantly higher in non-survivors than in survivors (p=0.042). Cox regression analysis revealed the association of female sex [odds ratio (OR)=0.318; 95% confidence interval (CI), 0.128-0.792; p=0.014] and scleroderma-related PAH (OR=0.347; 95% CI, 0.140-0.860; p=0.022) with significantly lower risk (3.14 fold and 2.88 fold, respectively) of mortality. CONCLUSION Our findings indicate favorable efficacy, safety, and tolerability of long-term iloprost treatment in the management of PAH, whereas improved NYHA functional class was not accompanied with a significant change in 6MWD values. Patient age was a risk factor for clinical worsening, while female sex, scleroderma subtype, and lower NT-proBNP levels were associated with significantly lower mortality risk.
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Affiliation(s)
| | - İsmail Hanta
- Department of Chest Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Sümeyye Güllülü
- Department of Cardiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ersan Atahan
- Department of Chest Diseases, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tamer Sayın
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülfer Okumuş
- Department of Chest Diseases, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Pınar Önen
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yokuşoğlu
- Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Arzu Baygül
- Department of Biostatistics, Koc University School of Medicine, Istanbul, Turkey
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Richter MJ, Wan J, Ghofrani HA, Seeger W, Gall H, Rieth A, Tello K. Acute response to rapid iloprost inhalation using the Breelib™ nebulizer in pulmonary arterial hypertension: the Breelib™ acute study. Pulm Circ 2019; 9:2045894019875342. [PMID: 31588353 PMCID: PMC6740066 DOI: 10.1177/2045894019875342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
The Breelib™ nebulizer was designed to reduce iloprost inhalation times for patients with pulmonary arterial hypertension (PAH). In 30 patients with PAH, rapid inhalation of iloprost 2.5 µg using Breelib™ caused significant improvements in invasively measured afterload and cardiac index but not echocardiographic right ventricular strain during 30 min post-inhalation.
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Affiliation(s)
- Manuel J Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, National Pulmonary Embolism & Pulmonary Vascular Diseases Research Group, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Hossein A Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.,Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany.,Department of Medicine, Imperial College London, London, UK
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
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Choi H, Jeon J, Huh J, Koo J, Yang S, Hwang W. The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial. J Clin Med 2019; 8:jcm8070982. [PMID: 31284472 PMCID: PMC6678452 DOI: 10.3390/jcm8070982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO2), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO2 in the IL10 group was comparable to that in the control group, whereas PaO2 in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, p < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, p < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, p < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, p < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, p < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, p < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.
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Affiliation(s)
- Hoon Choi
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Joonpyo Jeon
- Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 93-6, Jingwan-dong, Eunpyeong-gu, Seoul 122200, Republic of Korea
| | - Jaewon Huh
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Jungmin Koo
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Sungwon Yang
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Wonjung Hwang
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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