Radiographic lung disease and response of persistent pulmonary hypertension to mean airway pressure and alkalosis

Objective The study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN). Study Design We conducted a retrospective chart review of 30 patients with PPHN from January 2014 to November 2018, who did not respond to inhaled nitric oxide (iNO) alone and received inhaled iloprost. Twenty-two patients met the inclusion criteria and eight patients were excluded from the study (complex cardiac disease and extreme prematurity). Patients were categorized as responders or nonresponders (patients who required extracorporeal membrane oxygenation or died). Oxygenation index, mean airway pressure (MAP), and arterial partial pressure of oxygen (PaO2) were recorded. Results Among a total of 22 patients who were included in the study, 10 were classified as nonresponders as they required either extracorporeal membrane oxygenation or died. Gestational age and gender did not differ between responders and nonresponders. The median PaO2 was lower (37 vs. 42 mm Hg; p < 0.05) and median MAP was higher (20 vs. 17 cm H2O; p < 0.02) in nonresponders compared with responders just prior to initiating iloprost. Iloprost responders had a significant increase in median PaO2 and decrease in median oxygenation index in the 24 hours after initiating treatment (p < 0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost. Conclusion Inhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone. Key Points

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Pulmonary Vascular Endothelial Growth Factor and Flt-1 in Fetuses, in Acute and Chronic Lung Disease, and in Persistent Pulmonary Hypertension of the Newborn

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.164.10.2012036 ◽

2001 ◽

Vol 164 (10) ◽

pp. 1981-1987 ◽

Cited By ~ 207

Author(s):

PATRIK LASSUS ◽

MAILA TURANLAHTI ◽

PÄIVI HEIKKILÄ ◽

LEIF C. ANDERSSON ◽

IRMELI NUPPONEN ◽

...

Keyword(s):

Vascular Endothelial Growth Factor ◽

Pulmonary Hypertension ◽

Growth Factor ◽

Lung Disease ◽

Chronic Lung Disease ◽

Persistent Pulmonary Hypertension ◽

Vascular Endothelial ◽

Endothelial Growth Factor

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Pulmonary hypertension after postlavage lung injury in rabbits: possible role of polymorphonuclear leukocytes

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.5.1990 ◽

1991 ◽

Vol 71 (5) ◽

pp. 1990-1995 ◽

Cited By ~ 6

Author(s):

R. Burger ◽

A. C. Bryan

Keyword(s):

Pulmonary Hypertension ◽

Gas Exchange ◽

Lung Injury ◽

Arterial Pressure ◽

Airway Pressure ◽

Pulmonary Arterial Pressure ◽

Lung Lavage ◽

High Frequency Ventilation ◽

Mean Airway Pressure ◽

Pulmonary Arterial

Previous studies showed that repeated lung lavage leads to a severe lung injury with very poor gas exchange, a substantial protein leak into the alveoli with hyaline membrane formation, pulmonary hypertension, and migration of granulocytes (PMN) into the alveolar spaces. Depletion of PMN leads to a better gas exchange and a markedly decreased protein leak with only scanty hyaline membranes. In this study we show that there is sustained pulmonary hypertension after the lung lavage, but in PMN-depleted rabbits there is no postlavage increase in pulmonary arterial pressure. Changing the shunt fraction by manipulating mean airway pressure still leads to a hypoxic vasoconstriction with increase of pulmonary arterial pressure. Thus, after lung lavage, pulmonary reactivity to hypoxia is still preserved. Comparisons between high-frequency ventilation and conventional mechanical ventilation at the same mean airway pressures showed that equal mean airway pressure in these two very different modes of ventilation do not translate into the same mean functional lung volumes.

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Comparison between Patients with Persistent Pulmonary Hypertension of Neonates Concomitant with Parenchymal Lung Disease and Idiopathic Persistent Pulmonary Hypertension of Neonates

Neonatal Medicine ◽

10.5385/nm.2017.24.4.157 ◽

2017 ◽

Vol 24 (4) ◽

pp. 157

Author(s):

In Kyung Ryu ◽

Chih Lung Tang ◽

Shou Yu Chu ◽

Gyu Hong Shim ◽

Myoung Jae Chey

Keyword(s):

Pulmonary Hypertension ◽

Lung Disease ◽

Persistent Pulmonary Hypertension ◽

Parenchymal Lung Disease ◽

Parenchymal Lung

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Efficacy and safety of endotracheal instillation of iloprost for persistent pulmonary hypertension of the newborn

Cardiology in the Young ◽

10.1017/s1047951121005072 ◽

2022 ◽

pp. 1-7

Author(s):

Asli Okbay Gunes ◽

Murat Ciftel ◽

Mehmet Emcet Timur ◽

Ceren Dedebali ◽

Betul Zehra Pirdal

Keyword(s):

Pulmonary Hypertension ◽

Oxygen Saturation ◽

Saturation Index ◽

Persistent Pulmonary Hypertension ◽

Systolic Pulmonary Artery Pressure ◽

Mean Airway Pressure ◽

Pressure Oxygen ◽

Before And After ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen

Abstract Objective: To determine the efficacy and safety of endotracheal instillation of iloprost as a rescue therapy for persistent pulmonary hypertension of the newborn. Methods: Neonates diagnosed with persistent pulmonary hypertension who were unresponsive to standard treatment protocol applied for persistent pulmonary hypertension in our unit, and who were being followed up with mechanical ventilation, were included in the study. Iloprost was instilled endotracheally as a rescue treatment. Systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, fraction of inspired oxygen, preductal and postductal venous oxygen saturation, heart rate, and blood pressure were recorded before and after 30 minutes of endotracheal iloprost instillation. Adverse events after endotracheal iloprost were recorded. Results: Twenty neonates were included. The median gestational age and birth weight were found to be 37 (30.5-38) weeks and 2975 (2125-3437.5) grams, respectively. When compared to the period before endotracheal iloprost instillation, systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, and fraction of inspired oxygen values significantly decreased (p < 0.001, p < 0.001, p = 0.021, p = 0.001, respectively), whereas preductal and postductal oxygen saturation values significantly increased 30 minutes after the endotracheal iloprost instillation (p = 0.002, p < 0.001, respectively). There were no significant differences in heart rate and blood pressure values before and after the iloprost administration. No adverse events were observed. Conclusion: Endotracheal instillation of iloprost was found to be an effective and safe therapy for persistent pulmonary hypertension unresponsive to conventional treatment.

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