- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca, Opsumit (macitentan) / Nippon Shinyaku, J&J, VentaProst (epoprostenol inhalation) / Aerogen Pharma
Spinal Cord Infarction Associated With VA-ECMO Support (San Diego Convention Center, Room 1A-B (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_7690;
Despite antibiotics and transitioning to IV epoprostenol and inhaled nitric oxide, she progressed to RV failure and shock...PAH patients on peripheral VA-ECMO support often have minimal hypoxia and preserved LV systolic function shifting the mixing interface to the distal aorta. Potential interventions such as cannulation reconfiguration or adjusting ECMO flow to move the mixing interface have been proposed.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Rescue Awake Venovenous Extracorporeal Membrane Oxygenation With Right Ventricular Support in Secondary to COVID-19, A Case Series (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5896;
Despite treatment with inhaled epoprostenol and diuretics, she had worsening hypoxemic respiratory failure that required high flow nasal cannula of 100% FiO2 with declining oxygen saturations.For both cases, multidisciplinary discussion concluded that awake VV-ECMO with right ventricular support (ProtekDuo) would optimize nutrition, physical activity, and candidacy of potential lung transplantation...These cases reflect a subset of patients with a high mortality and morbidity, especially if mechanical ventilation is involved in the treatment course. In these selected cases, we believe that early application of VV ECMO improved outcomes by avoiding the complications of mechanical ventilation, rather than using it for salvage therapy in mechanically ventilated patients with refractory hypoxemia.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma, Vecuron (vecuronium) / Sun Pharma
Denied Extracorporeal Membrane Oxygenation Due to Morbid Obesity: A Case Report (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5892;
Emerging evidence suggests elevated BMI may be associated with decreased mortality in ARDS patients on ECMO. More research is needed to prevent inappropriate exclusion of this population.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Systemic Lupus Erythematous Presenting Primarily as Pulmonary Arterial Hypertension (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1553;
Based on her labs and clinical findings she was confirmed to have SLE (thrombocytopenia, pleural and pericardial effusion, low C3, and anti-Smith ab) and started on Plaquenil and steroids...It is important to note that patients with SLE-associated PAH, have a poorer prognosis than those without it. With earlier recognition and the use of vasodilator therapies, the prognosis has improved.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Review, Journal, Surgery: Inhaled Pulmonary Vasodilators for the Treatment of Right Ventricular Failure in Cardio-Thoracic Surgery: Is One Better than the Others? (Pubmed Central) - Jan 23, 2024
The largest ongoing randomized controlled trial on adults (INSPIRE-FLO) is addressing whether inhaled Epoprostenol and inhaled nitric oxide are similar in preventing RVF after heart transplants and left ventricular assist device placement, and whether they are similar in preventing primary graft dysfunction after lung transplants...If severe refractory postoperative RVF occurs, IPVs should be combined with complementary pharmacology (inotropes and inodilators). If unsuccessful, right ventricular mechanical support should be established.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Journal, Surgery: Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery. (Pubmed Central) - Nov 3, 2023
P4
If unsuccessful, right ventricular mechanical support should be established. Among patients undergoing major cardiac surgery for advanced heart failure, inhaled pulmonary-selective vasodilator treatment using iEPO was associated with similar risks for RVF development and development of other postoperative secondary outcomes compared with treatment using iNO.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
An Uncommon Mass, in an Uncommon Location, in a Common Patient? (Zone 4, Science and Technology Hall, Level 2) - Sep 21, 2023 - Abstract #AHA2023AHA_7052;
With approximately fifty cases reported in the literature, most achieved temporary remission. Our approach to management included chemotherapy with decitabine and cytarabine and subsequent external-beam radiotherapy.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Persistent Supra-Systemic Pulmonary Artery Hypertension Following Mitral Valve Replacement (Exhibit Hall) - Aug 23, 2023 - Abstract #ASA2023ASA_5913;
His postoperative course was c/b persistent pulmonary artery hypertension despite use of three pulmonary vasodilators (inhaled epoprostenol, inhaled nitric oxide, and IV treprostinil). On POD7, the patient suffered a PEA arrest following persistent supra-systemic pulmonary artery pressures c/b suspected pulmonary vasculature rupture and inability to achieve ROSC.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Tee Guided Cannulation For Ecpr, In The Ed, With Post-cannulation Impella Placement (Exhibit Hall) - Aug 23, 2023 - Abstract #ASA2023ASA_3758;
He had 2 witnessed cardiac arrest in the ED and was intubated, started on inhaled epoprostenol and cannulated for eCPR via femoral-femoral VA-ECMO in the ED with TEE guidance by anesthesiology shock team...On hospital day 6, ECMO was decannulated. Impella was removed the following day and he was extubated on hospital day 8.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Review, Journal: A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome. (Pubmed Central) - Aug 17, 2023
A literature search of MEDLINE was performed using the following search terms: inhaled prostaglandins, inhaled epoprostenol, inhaled nitric oxide, ARDS, critically ill...The use of inhaled prostaglandins can be considered in critically ill patients with COVID-19-associated ARDS or non-COVID-19 ARDS who are experiencing difficulties with oxygenation refractory to nonpharmacologic strategies. The use of iEPO and other inhaled prostaglandins requires further investigation to fully elucidate their effects on clinical outcomes, but it appears these medications may have a potential benefit in COVID-19-associated ARDS and non-COVID-19 ARDS patients with refractory hypoxemia but with little effect on mortality.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Journal: Impact of Inhaled Epoprostenol in Patients on COVID-19 Acute Respiratory Distress Syndrome (ARDS). (Pubmed Central) - Jul 10, 2023
Based on maximum ventilator settings during the first 3 days of inhaled epoprostenol use, there were no statistically significant differences between the 2 groups except for an unexpectedly lower oxygen saturation in the epoprostenol group. The use of inhaled epoprostenol did not have a statistically significant effect on ventilator-free days, ventilator settings, hospital and ICU LOS, and overall in-hospital mortality.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Journal: Safety of Nurse-Managed Inhaled Nitric Oxide During Critical Care Interfacility Transport. (Pubmed Central) - May 25, 2023
iNO was continued on 10 patients and initiated on 8 patients, 2 of whom were transitioned from inhaled epoprostenol...All 3 patients who experienced hypotension were already on vasopressor support and the hypotension resolved with medication titration. This study shows that iNO administration can be safely managed by appropriately trained nurses.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Journal: Inhaled Epoprostenol and Milrinone Effect on Right Ventricular Pressure Waveform Monitoring. (Pubmed Central) - Apr 11, 2023
Coadministration of iE&iM in cardiac surgery patients presenting with PH or signs of RV dysfunction is a safe and effective treatment approach in improving RV function. Appearance of a transient increase in RVOT gradient after iE&iM could be useful to predict response to treatment.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Respiratory Failure Due to "Triple Overlap Syndrome" in a Young Woman With Obesity (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8639;
Given her persistently low paO2/FiO2 ratio, it was decided to prone her and initiate inhaled epoprostenol...Even with endotracheal intubation, she continued to get progressively more hypoxic despite no obvious ventilation/perfusion mismatch. We must better recognize how obesity-related respiratory disorders interact and overlap with the characteristics of obstructive airway disease to better understand how to improve outcomes in these complex patients.
- |||||||||| tadalafil / Generic mfg.
The Straw That Broke the Camel (Walter E. Washington Convention Center, Area J, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8295;
The intima of the pulmonary artery is theorized to be predisposed to tearing and shear stress in the setting of significant increases in pulmonary arterial pressure due to the lower pressures typically present in the PA. We are aware of few case reports of PAD occurring following oral phosphodiesterase-5 inhibitor discontinuation in patients with severe PH, COPD, and previous pulmonary venous thromboembolic disease.
- |||||||||| epoprostenol intravenous / Generic mfg.
Refractory Bronchospasm Due to Inhaled Veletri in a Patient With Acute COVID-19 Associated Respiratory Failure (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_6832;
Inhaled epoprostenol is a common therapy for refractory hypoxemia in patients with COVID-19 Adult Respiratory Distress Syndrome (CARDS) and right heart failure...He received dexamethasone 6mg and Bebtelovimab 175mg intravenously as well as empiric antibiotics. Remdesivir was withheld due to AKI...Within two hours of Veletri
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Tumoral Pulmonary Hypertension; A Rare but Severe Cause of Pulmonary Hypertension (Walter E. Washington Convention Center, Area L, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5840;
Treatment options include early initiation of chemotherapy, pulmonary vasodilators, and anti-inflammatory approaches including glucocorticoids and Imatinib. Prognosis is poor and life expectancy is limited even after acute management of PTE.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
Acute Right Heart Failure in a Patient With a Massive Pulmonary Artery Aneurysm During a Long-haul Flight (Walter E. Washington Convention Center, Area B, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_5285;
CT angiography demonstrated aneurysmal dilatation of the main pulmonary artery with a diameter of 8.5cm, right pulmonary artery diameter of 5.0cm, and left pulmonary artery diameter of 3.0cm.She received diuresis, sildenafil, inhaled epoprostenol, and intravenous sodium bicarbonate...Her metformin and metoprolol were discontinued...Therefore, PAAs meeting a size threshold should be monitored and considered for prophylactic surgical repair. Though this patient
- |||||||||| Cytovene (ganciclovir) / Roche, TPOXX (tecovirimat) / SIGA Technologies, VentaProst (epoprostenol inhalation) / Aerogen Pharma
Disseminated Monkeypox as a Possible Cause of Acute Respiratory Distress Syndrome (Walter E. Washington Convention Center, Room 206 (Level 2)) - Mar 25, 2023 - Abstract #ATS2023ATS_2998;
Though this patient The patient was admitted and started a second series of tecovirimat...While initially intubated for loss of mental status, the patient progressed to prone positioning, paralysis and inhaled epoprostenol and required up to three vasoactive medications...Throughout the hospital stay, the patient received broad spectrum antibiotics including trimethoprim/sulfamethoxazole, antifungals, and ganciclovir as well as empiric steroids...In our case, extensive evaluations for alternate etiologies were unrevealing and we propose direct pulmonary involvement of disseminated monkeypox as a potential etiology of our patient
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
The Overlooked Side Effect - A Case of Inhaled Nitric Oxide-induced Methemoglobinemia in Severe Acute Respiratory Distress Syndrome (Marriott Marquis Washington, Marquis Ballroom, Salons 9-10 (Level M2)) - Mar 25, 2023 - Abstract #ATS2023ATS_2578;
Decision was made to transition from iNO to inhaled epoprostenol as the alternative pulmonary vasodilator...In addition, methemoglobinemia causes oxygen saturation reading in routine pulse oximetry to be approximately 85 percent, regardless of the true hemoglobin oxygen saturation. In patients with severe ARDS, such side effect can lead to not only misinterpretation of severity of lung injury, but also life-threatening hypoxia in the setting of existing severe lung disease and intolerance of further reduced oxygen delivery.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
CENTRAL VENOUS CATHETER PLACEMENT IN A PRONE POSITIONED PATIENT: POSTERIOR LATERAL APPROACH () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1838;
The patient remained with refractory hypoxemia despite prone positioning, optimal ventilator settings and inhaled epoprostenol...A steep 90 degree angle to access the RIJ was intentionally attempted to minimize the amount of soft tissue to dilate. Utilizing this approach allowed us to safely and effectively place the line without immediate complications.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
COMPARING OUTCOMES IN RESPONDERS VERSUS NONRESPONDERS TO INHALED EPOPROSTENOL IN COVID-19 ARDS () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1799;
Utilizing this approach allowed us to safely and effectively place the line without immediate complications. Despite over 50% of patients in cohort responding to iEPO as demonstrated by significant improvement in oxygenation there was no difference in patient outcomes noted in responders as compared to non-responders.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
CHARACTERIZATION OF INHALED EPOPROSTENOL USE IN ACUTE PULMONARY EMBOLISM () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1794;
iEPO use generally followed our institutional guidelines with maximum dose and weaning strategies; however, it was weaned in only about half of patients. Systemic hypotension requiring vasopressors was experienced, which may warrant closer monitoring of therapy.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
EVALUATION OF RESPONSE RATE TO FIXED-DOSE INHALED EPOPROSTENOL () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1753;
A majority of patients who survived to iEPO cessation without down-titration experienced a drop in P:F. Protocol revision to include guidance on therapeutic response and down-titration may be warranted.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
FIGHTING THE CLOCK AGAINST OBSTRUCTIVE SHOCK () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1574;
SVCS in the setting of malignancy is an oncologic emergency with significant morbidity and mortality that requires immediate treatment. As there are no evidence-based treatment guidelines, initial treatment should focus on temporizing until definitive treatment (chemotherapy and/or radiation) can be initiated.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
REFRACTORY HYPOXEMIA SECONDARY TO ACUTE RIGHT-TO-LEFT SHUNT RESULTING FROM SEVERE MITRAL VALVE REGURGITATION (Poster Hall_Hall F) - Jan 4, 2023 - Abstract #ACCWCC2023ACC_WCC_6583;
Inhaled epoprostenol was initiated, which immediately resolved hypoxemia, further supporting right-to-left shunt as the primary contributor... Refractory hypoxemia should be evaluated by echocardiography for presence of an intracardiac shunt and additional structural contributors to shunt physiology.
- |||||||||| VentaProst (epoprostenol inhalation) / Aerogen Pharma
HYPOXIA, HEMOPTYSIS AND HEADACHE: A CASE OF EISENMENGER SYNDROME DUE TO A LARGE VSD IN A YOUNG ADULT (Poster Hall_Hall F) - Jan 4, 2023 - Abstract #ACCWCC2023ACC_WCC_6333;
Despite this, she experienced worsening hypoxia (requiring 40L high-flow nasal cannula) so pulmonary vasodilator (PVD) therapy was escalated to IV epoprostenol and inhaled nitric oxide which did significantly improve oxygenation...Given the concern for PA thrombosis, anticoagulation (AC) with warfarin was initiated...The AC was reversed and inhaled tranexamic acid was administered...She was ultimately able to be transitioned to long-term PVD therapy of ambrisentan and sildenafil and discharged home on only 2L oxygen. ES is a life-threatening cause of PAH in adults and carries significant morbidity.
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