Retrospective evaluation of inhaled prostaglandins in patients with acute respiratory distress syndrome

Study Objectives. To determine whether use of inhaled alprostadil (PGE ₁) or epoprostenol (PGI₂) significantly improved oxygenation in patients with acute respiratory distress syndrome (ARDS), and to determine whether differences between the two drugs exist with regard to oxygenation, duration of mechanical ventilation and hospitalization, adverse effects, and survival. Design. Retrospective chart review. Setting. A 360-bed tertiary care teaching facility with medical and surgical intensive care units. Patients. Twenty-seven patients admitted to the hospital who received either PGI₂ or PGE₁ for a primary or secondary diagnosis of ARDS. Measurements and Main Results. Seventeen patients received inhaled PGE ₁ and 10 received inhaled PGI₂. There were no significant changes in the ratio of arterial partial pressure of oxygen (PaO ₂):fraction of inspired oxygen (FiO₂) and in the PaO ₂, from baseline to any time point that was analyzed during treatment, for patients receiving either PGE₁ (p=0.2120 and 0.3399, respectively) or PGI₂ (p=0.1655 and 0.0784, respectively). Conclusion. No statistically significant improvement in oxygenation was observed in patients receiving either PGE₁ or PGI₂. In addition, no significant differences were found between the two prostaglandins for the variables studied. Until positive results from large, prospective studies are available, we recommend that these inhaled prostaglandins not be used to treat ARDS.