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Submitted: 07 July 2008
HERDIN Record #: PCHRD070908030730

The use of aerosolized prostacyclin analogue (Iloprost) in the prevention of post-operative pulmonary hypertensive crisis among children with left-to-right shunts and moderate to severe pulmonary artery hypertension .

Maria Eloisa R. Lazaro,
Ruzenette Felicitas R. Hernandez,
Ma Lourdes S. Casas,
Blandina Trinidad F. Ferrera,
Magdalena J. Lagamayo,
Jhuliet J. Balderas

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ The natural history of an uncorrected congenital heart disease especially after two years of age is the development of pulmonary hypertension. Among left -to-right shunts, when the pre-operative pulmonary artery pressure rises about two-thirds the systolic blood pressure, the risk for postoperative pulmonary hypertensive crisis increases and determines the surgical risk, morbidity, and mortality. This study was therefore conceptualized to determine the effect of inhalational or aerosolized prostacyclin analogue (Iloprost) in the prevention of postoperative pulmonary hypertensive crisis when given at least 48 hours in the postoperative period. The specific objectives are: (1) to determine the effect of aerosolized Iloprost on the oxygen saturation, systolic and diastolic BP, tricuspid and pulmonary regurgitations, pulmonary artery pressure, Qp/Qs and pulmonary vascular resistance (RpRs), and (2) to determine the effect on the following clinical parameters: occurrence of pulmonary hypertensive crisis, length of hospital stay, duration of mechanical ventilation, and in-house mortality.

Method ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ This is a randomized double-blind placebo controlled study. Patients were divided into two groups: Group I received every 6 hours aerosolized Iloprost for 48 hours, and group II was the control group, given nebulized saline solution. Randomization was done by using a table of random samples. Evaluation of parameters was done at 0-hour, 24- hour, and 48-hour postoperatively. There were 19 patients enrolled in the study: ten in Group I and nine in Group II. Aerosolized Iloprost was given at a dose of 25 ng. kg min and was given at 6-hour interval for 48 hours.

Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ There was no difference in the tricuspid regurgitation jet in both groups, but a significant dropped in pulmonary regurgitation jet was noted in the Iloprost group 48 hours post-operatively (p 0.040). Pulmonary artery pressure analysis showed a more significant drop at the end of 48 hour (p 0.002). Both groups showed a decrease in pulmonary vascular resistance with a higher drop in the placebo group at 24 hours (p 0.028) and a more significant decrease at 48 hours in the Iloprost group (p 0.012). There was a decreasing trend in the Qp/Qs ratio from pre-operative levels to 48 hours post-operatively but these were not statistically significant. Increasing the sample size is recommended. No mortality in both groups with no side effects noted.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Aerosolized Iloprost given every 6 hours can be an important pharmacologic agent to modify the pulmonary vascular bed in the immediate postoperative period to prevent pulmonary hypertensive crisis among children with CHD who undergo surgical correction. It is suggested that pre-operative aerosolized Iloprost nebulization as preoperative pulmonary vasodilatation may be started 48 hours preoperatively to significantly drop the PAP and pulmonary vascular resistance in the immediate post-operative period. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
April-June 2006
Volume
12
Issue
2
Page(s)
14-21

Objectives

General Objective: To determine the effect of aerosolized Prostacyclin analogue (Iloprost) in the prevention of pulmonary hypertensive crisis when given at least 48 hours in the immediate post-operative period.

Specific Objectives:
1. To compare the effect of inhaled Iloprost post-operatively on the following parameters:
1.1 Oxygen saturation
1.2. Systemic blood pressure
1.3. Diastolic blood pressure
1.4. Tricuspid regurgitation
1.5. Pulmonary regurgitation
1.6. Pulmonary artery pressure by PAT
1.7. Qp/Qs
1.8. Pulmonary vascular resistance

2. To determine its effect as to:
2.1 presence of pulmonary hypertensive crisis
2.2 length of hospital stay
2.3 duration of mechanical ventilation
2.4 in-hospital mortality.

3. To determine its adverse reactions if any among children with secondary pulmonary hypertension undergoing cardiopulmonary bypass.

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)