TRIAL OF INHALED ALPROSTADIL TO IMPROVE HYPOXIA AND PULMONARY HYPERTENSION

ABSTRACT

Background: Aerosolized PGE1 (Alprostadil) can result in a selective pulmonary vasodilatation without affecting the systemic blood pressure as shown in preliminary studies/case reports. No large clinical trials have been done for this type of use of the drug.

Aims: To see if nebulized Iloprost¹, a stable prostacyclin derivative, decreases pulmonary hypertension selectively and improves oxygenation in ARDS.

Setting:  This randomized, prospective, double blind study was done in the ICU of Aga Khan University Hospital, Karachi..

Patients and Methods: Sixty 60 patients with ARDS who were admitted in the multidisciplinary ICU at AKUH were included in the study. All cases were adults with ARDS and/or PA pressures > 35 mmHg on PA catheter or suspected on clinical grounds. A transthoracic echo was performed along with recording of Pulmonary Artery pressures (PA) on echo and P/F (full) ratio prior to drug administration. Subsequently each patient was randomized in the pharmacy in a block computerized randomization to either case or control. Cases received nebulized PGE1 over 30 minutes in the ICU.  Following this the echo and arterial blood gases were repeated. The controls received normal saline placebo. The patients were given the drug as extra drug along with standard therapy. There was no cross over as there were no adverse events reported.

Results: The patients who received the drug showed marked improvements in oxygenation and Pulmonary artery pressures as shown by their blood gases and repeated echoes. Our results on the paired T -test before and after the drug showed a p -value of 0.035 for PaO2/ FiO2 ratio and a p- value of 0.000 for PA pressures, both of which were strongly significant.

Conclusion: The study showed a significant improvement in PA pressures and oxygenation after administration of nebulised alprostadil.