(1241) Inhaled Epoprostenol for Patients With Acute Respiratory Failure

Introduction: Inhaled epoprostenol is a potential treatment for patients with acute respiratory failure to attenuate severe hypoxemia. This study evaluated the effectiveness of inhaled epoprostenol in improving oxygenation in patients with severe hypoxemia and assessed the impact on duration of mechanical ventilation, length of stay, and mortality.

Methods: This multicenter retrospective cohort study included adult patients who received inhaled epoprostenol from 02/01/2020 to 07/31/2022. Patients who received inhaled epoprostenol after cardiac surgery, received inhaled nitrous oxide, or received intravenous epoprostenol were excluded. The primary outcome, a 20% increase in PaO2:FiO2 ratio, or 20% reduction in mean pulmonary arterial pressure, or 20% increase in cardiac output or index was calculated using the most recent arterial blood gas collected within 12 hours before inhaled epoprostenol initiation and the first collected 30 to 60 minutes or up to 12 hours after. Secondary outcomes explored for patients who achieved the primary outcome versus those that did not included escalation of care, duration of mechanical ventilation, length of hospital and intensive care unit stay, and in hospital mortality.

Results: Fifty patients were included. Median age was 60 years, median body mass index 35 kg/m2, and median APACHE score 24, with 68.4% of patients being male. The most common reason for admission was acute hypoxic respiratory failure secondary to pneumonia. A positive response to inhaled epoprostenol was seen in 17 (34%) of patients. There were no differences in secondary outcomes for patients that achieved a positive response for the primary outcome versus those that did not with respect to escalation of care (5 [29.4%] vs 6 [18.2%], p=0.364), duration of mechanical ventilation after epoprostenol initiation (4.1 vs 6.4 mean days, p=0.175), length of hospital stay (11.0 [+/- 8 days] vs 14.3 [+/-13.7 days], p=0.280), intensive care unit length of stay (9.2 [+/- 8.9 days] vs 12.1 [+/-11.7 days], p=0.348), and in hospital mortality (14 [82.4%] vs 27 [81.8%], p=0.963).

Conclusions: The use of inhaled epoprostenol in patients with acute hypoxemic respiratory failure improved oxygenation in selected patients with no differences in duration of mechanical ventilation, length of stay, or mortality.