ROLE OF PGE(1) AND PGI(2) IN THE THERAPEU TIC MANAGEMENT OF PULMONARY-HYPERTENSION

The vasodilatory prostanoids PGE1 and PGI2 Offer as therapeutic agents for patients with critical pulmonary hypertension and right heart dec ompensation under intensive care conditons. By use of chronic ambulato ry PGI2 infusion, patients with primary pulmonary hypertension may be bridged for (heart-)lung transplantation. In patients with ARDS and se psis, vasodilatory prostanoids may possibly increase oxygen delivery a nd influence altered blood flow in microcirculation and thereby preven t or reduce multiple organ failure. The prostanoids PGE1 and PGI2 poss ess strong vasodilatory potency in the pulmonary circulation neverthel ess indications are rare for intravenous application due to limited pu lmonary and intrapulmonary selectivity. PGE1 and PGI2 decline systemic vascular resistance (limited pulmonary selectivity) and general pulmo nary vasodilatation induce or enhance ventilation-perfusion mismatch a ccompanied by an impairment of gas exchange conditions (limited intrap ulmonary selectivity). Application of the vasodilatative prostanoids v ia the transbronchial route (aerosol) may offer as future perspective to achieve pulmonary and intrapulmonary selectivity.