Evaluation of Inhaled Alprostadil in Hospitalized Adult Patients

Abstract

Background: Intermittent inhaled alprostadil (iPGE₁) may be a viable alternative to inhaled nitric oxide or epoprostenol for management of right ventricular failure, pulmonary hypertension (pHTN) or acute respiratory distress syndrome (ARDS). However, limited evidence exists regarding iPGE₁ use in adults, ideal dosing strategies, or optimal use cases.

Objective: To describe the clinical characteristics of patients receiving iPGE₁ and identify specific sub-populations warranting further research.

Methods: This was a single-center, retrospective, descriptive analysis of inpatients who received at least one dose of iPGE₁. The primary outcome was to describe patient characteristics and alprostadil dosing strategies. Secondary outcomes included changes in respiratory support requirements, hemodynamics, and inotropic/vasoactive use. Outcomes were stratified and compared based on primary therapeutic indication (cardiac or pulmonary).

Results: Fifty-four patients received iPGE₁ 40 (75%) for pulmonary (pHTN or ARDS) and 14 (25%) for cardiac indications. There was no difference between indications in the number of patients de-escalated from level of respiratory (53% vs 57%, P = 0.76), inotropic (70% vs 57%, P = 0.39), or vasopressor support (78% vs 57%, P = 0.17). Furthermore, there was no significant improvement in cardiopulmonary parameters at multiple time intervals after iPGE₁ initiation.

Conclusion and relevance: This is the largest study to date on the use of intermittent iPGE₁ in adults. Alprostadil was safely utilized in novel populations; however, efficacy as evaluated by clinical or surrogate endpoints could not be demonstrated and further investigation is needed to determine its potential and optimal place in therapy.

Keywords: acute respiratory distress syndrome; alprostadil; epoprostenol; inhaled nitric oxide; right ventricular failure.