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Inhaled epoprostenol improves oxygenation in severe hypoxemia

Tabrizi, Maryam Bita MD; Schinco, Miren A. MD; Tepas, Joseph J. III MD; Hwang, James MD; Spiwak, Elizabeth MD; Kerwin, Andrew J. PA-C

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p 503–506
doi: 10.1097/TA.0b013e318258431e

BACKGROUND Epoprostenol (Flolan), an inhalational epoprostenol vasodilator, increases pulmonary arterial flow and decreases pulmonary pressures, thereby improving gas exchange and arterial oxygenation. We evaluated the benefits of inhaled epoprostenol as a less expensive alternative to nitric oxide in ventilated surgical intensive care patients with severe hypoxemia.

METHODS After institutional review board approval was obtained, the records of mechanically ventilated surgical intensive care unit patients who received epoprostenol as a therapy for severe hypoxia (SaO2 < 90%) in a tertiary care referral center were retrospectively reviewed. Initial PaO2/FIO2 (P/F) ratio and oxygen saturation were compared with values at 12 and 48 hours after the administration of epoprostenol. One-way repeated-measures analysis of variance compared improvements in oxygenation. Further subgroup analyses evaluated differences among trauma, nontrauma patient subgroups, time to initiation of epoprostenol, and age.

RESULTS During a 20 month-interval beginning February 2009, 36 patients (23 trauma and 13 nontrauma; age, 15–80 years) were treated. Epoprostenol significantly improved both P/F ratio and oxygen saturation in both trauma and nontrauma patients. There was no difference between subgroups. Larger improvements in P/F ratio were seen when epoprostenol was started within 7 days. Response between age groups did not differ significantly. Subgroup analysis of mortality (trauma, 60.9% vs. nontrauma, 61.5%) failed to show any differences.

CONCLUSION Treatment with inhaled epoprostenol improved gas exchange in severely hypoxemic surgical patients. Earlier intervention (within 7 days of intubation) was more efficacious at improving oxygenation.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Department of Surgery, University of Florida Health Sciences Center, Jacksonville, Florida.

Submitted: December 2, 2011; Revised: March 12, 2012; Accepted: March 30, 2012.

This study was presented as a poster at the 25th annual meeting of the Eastern Association for the Surgery of Trauma, January 10–14, 2012, in Lake Buena Vista, Florida.

Address for reprints: Miren A. Schinco, MD, 655 W. 8th Street, Jacksonville, FL 32209;email:

© 2012 Lippincott Williams & Wilkins, Inc.