Inhaled prostacyclin (PGI(2)) is an effective addition to the treatment ofpulmonary hypertension and hypoxia in the operating room and intensive care unit

Purpose: There is a growing interest in the intraoperative and intensive ca re use of inhaled epoprostenol (PG12) for the treatment of pulmonary hypert ension (PHT) and hypoxia of cardiac or noncardiac origin. We report our exp erience with this form of therapy. Methods: A retrospective chart review of all patients who received inhaled PG12 over a one-year period was undertaken. Demographic, hemodynamic, oxyge nation status, mode of administration, side effects, duration of hospital s tay, and mortality were noted. Results: Thirty-five patients, of which 33 (92%) were in the intensive care unit, received inhaled PGI(2). Of the 27 patients whose pulmonary artery p ressure (PAP) was monitored, a significant decrease in mean PAP from 34.8 /- 11.8 mmHg to 32.1 +/- 11.8 mmHg was observed within one hour after the s tart of therapy (P=0.0017). Selective pulmonary vasodilatation occurred in 77.8% of the patients. Thirty-three patients had arterial blood gases befor e and after therapy. There was an improvement in the PaO2/FIO2 ratio in 88% of these with a 175% improvement on average. The ratio of PaO2/FO2 improve d from 108 +/- 8 to 138 +/- 105 (P = 0.001). Six patients (17%) presented h ypotension, two had subsequent pneumothorax, one had bronchospasm and in on e patient PG12 inhalation was stopped because of increasing peak pulmonary pressures from the secondary flow coming from the nebulizer, Mortality of t he cohort was 54%. Conclusion: Inhaled PGI(2) can be useful in the treatment of patients with PHT and severe hypoxia. It can however be associated with systemic side eff ects.