Inhaled prostacyclin and platelet function after cardiac surgery and cardiopulmonary bypass

Objective. To study the effects of 6 h inhalation of aerosolized prostacycl in (PGI(2)) on platelet function. Design: In a prospective, double-blind, randomized study, 28 patients sched uled for elective cardiac surgery requiring cardiopulmonary bypass (CPB), r eceived either 0.9% sodium chloride (n = 8), PGI(2) 5 mu g x ml(-1) (n = 10 ) or PGI(2) 10 mu g, ml(-1) (n = 10) as an aerosol for 6 h postoperatively. Setting: Cardiothoracic intensive care unit at a university hospital. Inter ventions: All patients were studied immediately after surgery during mechan ical ventilation and sedation. The PGI(2) solutions or saline were administ ered with a jet nebulizer. Measurements and results: Bleeding time and chest tube drainage were measur ed. Blood samples for platelet aggregation, thrombelastography (TEG) and an alysis of coagulation parameters and the stable prostacy clin metabolite 6- keto-PGF(1)alpha were obtained immediately before inhalation and after 2, 4 and 6 h of inhalation. After 6 h of PGI(2) inhalation, regardless of admin istered dose, there was a lower rate of platelet aggregation and a lower ma ximal increase in light transmission in response to adenosine diphosphate ( ADP) than in the control group. The TEG variable reaction rime (R) was prol onged after 4 and 6 h of inhalation in the PGI(2) group receiving 10 mu g x ml(-1). There were no differences between groups with respect to bleeding time and chest tube drainage or any of the other variables examined. Conclusion: Inhalation of PGI(2) for 5 h in patients after cardiac surgery is associated with impaired platelet aggregation detected by in vitro techn iques, with no in vivo signs of platelet, dysfunction.