Epoprostenol Via High-Flow Nasal Cannula Improves Severe Hypoxemia in PH - Pulmonology Advisor

Posted: 11 Jul 2019 12:00 AM PDT

For patients with severe hypoxemia with pulmonary hypertension or right heart dysfunction, inhaled epoprostenol through high-flow nasal cannula increases oxygenation, according to a study published in Pharmaceutics.

The researchers of this retrospective study assessed the effect of inhaled epoprostenol using a high-flow nasal cannula on oxygenation and future mechanical ventilation in patients with hypoxemia comorbid with pulmonary hypertension or right heart dysfunction in an intensive care unit setting.

A chart review was completed on adult patients who were admitted into the respiratory care department of the Rush University Medical Center for severe hypoxemia between July 2015 and April 2018 and treated with inhaled epoprostenol through the high-flow nasal cannula. Demographic information, intake Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II scores, and clinical measurements were retrieved from patients' charts.

Of the 11 individuals included, 4 were men, 5 were white, the mean age was 57.5 years old, the mean APACHE II score was 18.5, 10 patients had chronic heart or lung comorbidities, and 7 patients used home oxygen. One patient did not respond to the inhaled epoprostenol.

Overall, the inhaled epoprostenol increased the average peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen ratio from 107.5 to 125.5 (P =.026) in 30 to 60 minutes, and responders (n=5) significantly improved SpO2 from 87.6% to 96.6% (P =.03).

There were no differences found among heart rate, blood pressure, and respiratory rate before and after inhaled epoprostenol. Outcomes included 7 patients not requiring intubation and 7 patients who were discharged.

Limitations of this study include its retrospective nature, the lack of a control group, the small sample size, and using SpO2/fraction of inspired oxygen ratio to evaluate oxygenation, rather than the partial pressure of oxygen/fraction of inspired oxygen ratio.

The researchers concluded that "[t]his retrospective study demonstrated the feasibility of inhaled epoprostenol via [high-flow nasal cannula] in improving oxygenation in adult subjects with severe hypoxemia with pulmonary hypertension or right heart dysfunction."

Reference

Li J, Harnois LJ, Markos B, et al. Epoprostenol delivered via high flow nasal cannula for ICU subjects with severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction.Pharmaceutics. 2019;11(6):281.

This article originally appeared on The Cardiology Advisor

Topics:

Critical Care Pulmonary Hypertension

CardioMEMS System Useful in Monitoring Heart Failure Risk in PAH, Study Shows - Pulmonary Hypertension News

Posted: 11 Jul 2019 12:00 AM PDT

Abbott's CardioMEMS HF system — a wireless heart failure monitor — can be safely used to monitor blood flow (hemodynamics) changes and help predict the risk of heart failure in people with pulmonary arterial hypertension (PAH), results from a pilot trial show.

Additional studies in larger groups of PAH patients are still needed to confirm the potential of this wireless implantable system to monitor the effects of PAH treatment, to ultimately improve individuals' outcomes and quality of life, the researchers said.

The trial results were reported in "Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor," published in the journal Chest. The study was led by researchers at Allegheny General Hospital in Pittsburgh, in collaboration with a team from Duke University.

PAH is a progressive disease that can lead to right heart dysfunction and failure. Close monitoring of blood pressure, and of the heart's function, is necessary to ensure adequate early treatment, and prevent disease worsening.

CardioMEMS is the first wireless, implantable monitor that continuously measures pulmonary arterial pressure — an early indicator of the onset of worsening heart failure — approved by the U.S. Food and Drug Administration (FDA).

The system uses a small pressure sensor, which is permanently implanted in the distal pulmonary artery using a right heart catheterization procedure. The collected data is then transmitted wirelessly and stored in a secure website that clinicians can easily access.

Use of the CardioMEMS system has been demonstrated to significantly reduce hospitalizations due to heart failure. It also provided useful clinical information for helping improve patients' quality of life.

"The development of ambulatory implantable hemodynamic monitors provides clinicians with remote access to daily cardiovascular measurements to monitor progression, guide therapy, and detect or prevent early decompensation," the researchers said.

In this study, the investigators explored the safety and diagnostic potential of the CardioMEMS system in people with severe PAH who were hospitalized within the previous year due to right-sided heart failure.

They implanted the monitoring system in 26 patients, with a mean age of 51.3 years. Among these patients, 81% had marked limitations of physical activity — ranked as Class III in the New York Heart Association (NYHA) Functional Classification, the most commonly used system for classifying heart failure.

Results showed that, upon a mean follow-up period of 2.5 years, the system's implantation protocol was safe.

Only one pre-implantation complication was reported, a microperforation of the pulmonary artery during preliminary vessel evaluation. After the sensor was implanted, no clinical complications or device safety issues were reported.

Direct CardioMEMS measurements provided information regarding patients' systolic, mean, and diastolic pulmonary artery pressure. It also provided data on heart rate, cardiac output, right ventricular activity, and total pulmonary resistance, among other clinical parameters.

Collected data showed that the system was able to detect significant changes in the different hemodynamic parameters while patients were on PAH therapy. The system also accurately identified early hemodynamic changes, which further demonstrated that CardioMEMS could be used to monitor the efficacy of PAH therapy.

Evaluation of participants' functional improvements over time — as determined by changes in the NYHA classification, exercise capacity, and patients' reported quality of life — confirmed that they were associated with positive hemodynamic changes detected by the CardioMEMS system.

The team believes that "serial monitoring of hemodynamics over time" with this implantable system "is feasible and may provide added value compared to a single rest set of measurements made in the catheterization lab."

Nonetheless, larger clinical trials are needed to compare CardioMEMS's diagnostic potential with standard available methods, the researchers said. These studies on CardioMEMS are needed "before its widespread use to guide therapy in severe PAH patients with right-sided HF [heart failure]" can be implemented, they said.

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