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July 22, 2007
July 8, 2007
Possible Alternative to Inhaled Nitric Oxide
By Brian Walsh, BS, RRT-NPS, RPFT
University of Virginia
Children’s Medical Center
Conclusion:
All studies demonstrate that the clinical response to inhaled PGI
2 in terms of selectively decreasing PAP without effecting SAP, and/or improved oxygenation is as good, if not better, than INO. Where continuous inhalation has been used, the rate of PGI 2
administration is comparable to the IV infusion dose, i.e. 1.5 to 50 ng/kg/min. Mikhail et al12 were unable to detect a dose response between 15 to 50 ng/kg/min suggesting that lower doses should be evaluated. In a dog model of hypoxic pulmonary vasoconstriction,
Zwissler et al found a dose of inhaled PGI 2 as low as 0.9 ng/kg/min caused a significant reduction in PAP27. The actual dose reaching the pulmonary vasculature is unknown as only approximately 10% of the initial dose of a nebulized agent reaches the alveolus28. Distal deposition of a nebulized drug is related to particle size; to achieve distal deposition a particle must be less than 5μm. No studies have been able to demonstrate tolerance to sustained treatment with
inhaled PGI 2 and, where repeated nebulized treatments have been given, there has been no evidence of deleterious rebound pulmonary hypertension in-between doses.
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