Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients. (Stockwell)

J Crit Care. 2013 May 14. pii: S0883-9441(13)00067-1. PMID: 23683572

PURPOSE: The purpose of this is to compare efficacy, safety, and cost outcomes inpatients who have received either inhaled epoprostenol (iEPO) or inhaled nitric oxide (iNO) for hypoxic respiratory failure.

MATERIALS AND METHODS: This is a retrospective, single-center analysis of adult, mechanically ventilated patients receiving iNO or iEPO for improvement in oxygenation.

RESULTS: We evaluated 105 mechanically ventilated patients who received iEPO (52patients) or iNO (53 patients) between January 2009 and October 2010. Most patientsreceived therapy for acute respiratory distress syndrome (iNO 58.5% vs iEPO 61.5%; P = .84). There was no difference in the change in the partial pressure of arterial O2/fraction of inspired O2 ratio after 1 hour of therapy (20.58 ± 91.54 vs 33.04 ± 36.19 [P = .36]) in the iNO and iEPO groups, respectively. No difference was observed in duration of therapy (P = .63), mechanical ventilation (P = .07), intensive care unit (P = .67), and hospital lengths of stay (P = .26) comparing the iNO and iEPO groups. No adverse events were attributed to either therapy. Inhaled nitric oxide was 4.5 to 17 times more expensive than iEPO depending on contract pricing.

CONCLUSIONS: We found no difference in efficacy and safety outcomes when comparing iNO and iEPO in hypoxic, critically ill patients. Inhaled epoprostenol is associated with less drug expenditure than iNO.

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