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Inhaled iloprost for the control of acute pulmonary hypertension in children: A systematic review

Mulligan, Claire PhD; Beghetti, Maurice MD, FESC

Pediatric Critical Care Medicine: July 2012 - Volume 13 - Issue 4 - p 472–480
doi: 10.1097/PCC.0b013e31822f192b
Review Article

Objective: Inhaled iloprost is attracting growing interest as a potential alternative and/or adjuvant to inhaled nitric oxide in the management of pediatric pulmonary hypertension in the acute and intensive care settings. However, there are currently no formal evidence-based guidelines regarding the use of inhaled iloprost in children with pulmonary hypertension. The aim of this systematic review is to assess the literature concerning the use of inhaled iloprost in children with pulmonary hypertension in the acute setting.

Data Sources: Studies were identified from PubMed and Embase. Internal literature databases and recent congress abstracts (2009 onward) were also searched for relevant publications.

Study Selection: Studies were included if they examined the use of inhaled iloprost in children with pulmonary hypertension in an acute or intensive care setting.

Data Extraction and Synthesis: Twenty-eight studies were included in the review. The majority were case studies or case series (n = 17), and in total, the 28 studies represented the treatment of 195 children with iloprost. Iloprost was most frequently studied in children undergoing cardiac surgery (as a bridge to surgery and postoperatively), in children undergoing acute pulmonary vasoreactivity testing, and in neonates with persistent pulmonary hypertension of the newborn. The results of the included studies suggested that inhaled iloprost may have a diverse role in the acute treatment of pediatric pulmonary hypertension and that its acute effects are similar to those of inhaled nitric oxide. However, the iloprost dose was not consistently reported and varied greatly between studies, and several different administration devices were used.

Conclusions: Inhaled iloprost may be useful in the acute treatment of children and neonates with pulmonary hypertension, but clinical data are scarce, and the appropriate dosing of iloprost in different scenarios is uncertain. Well-designed prospective clinical trials are needed.

Supplemental Digital Content is available in the text.

From the Research Evaluation Unit (CM), Oxford PharmaGenesis Limited, Oxford, U.K.; and the Pediatric Cardiology Unit (MB), Department of the Child and Adolescent, Children’s University Hospital, Geneva, Switzerland.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/pccmjournal).

The writing of this article was funded in part by Bayer HealthCare Pharmaceuticals. Dr. Mulligan is an employee of Oxford PharmaGenesisLimited, which has received project funding from Bayer HealthCare Pharmaceuticals. Professor Beghetti has served on advisory boards/consulting for Pfizer, Actelion Pharmaceuticals, Bayer HealthCare Pharmaceuticals, GlaxoSmithKline, INO therapeutics, Eli Lilly, and Mondobiotech and has received lecture fees from Actelion Pharmaceuticals, Encysive, Pfizer, and Bayer HealthCare Pharmaceuticals.

For information regarding this article, E-mail: maurice.beghetti@hcuge.ch.

©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies