Document Detail


Intravenous iloprost for treatment failure of aerosolised iloprost in pulmonary arterial hypertension.
MedLine Citation:
PMID:  12212965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Treatment with aerosolised iloprost, a prostacyclin analogue, has beneficial effects in patients with pulmonary arterial hypertension (PAH). It is unclear if patients, whose clinical condition deteriorates under treatment with aerosolised iloprost, benefit from switching to continuous intravenous iloprost. The current authors report on 16 patients with severe PAH who received continuous intravenous iloprost after primary or secondary failure of treatment with aerosolised iloprost. Determinants of efficacy were survival, New York Heart Association (NYHA) class, and walking distance in the 6-min walk test. Of 93 patients with PAH treated with aerosolised iloprost, 16 required switching to intravenous iloprost for clinical deterioration. These patients had severe right heart failure with a cardiac index of 1.6+/-0.2 L x min(-1) x m(-2) and a mixed-venous oxygen saturation of 52+/-6%. Five of these patients showed no improvement and eventually died. Three patients had further deterioration in NYHA class and exercise capacity; two of them underwent lung transplantation; the third patient is still alive. Eight patients showed marked clinical improvement; one underwent lung transplantation and the others are currently alive and stable. In the latter group of patients, the walking distance in the 6-min walk test increased from 205+/-94 to 329+/-59 m. It was not possible to identify clinical or haemodynamic factors that would predict whether switching from inhaled to intravenous iloprost would have a beneficial effect. In patients with pulmonary arterial hypertension who deteriorated while being treated with aerosolised iloprost, switching to continuous intravenous iloprost caused substantial improvement in exercise capacity in eight of 16 patients but could not prevent progression of pulmonary hypertension in the remaining eight patients. Since it was impossible to predict the individual effects of this approach, intravenous prostaglandin treatment should be considered in pulmonary arterial hypertension patients who deteriorate while receiving iloprost aerosol.
Authors:
M M Hoeper; E Spiekerkoetter; V Westerkamp; R Gatzke; H Fabel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The European respiratory journal     Volume:  20     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-09-05     Completed Date:  2003-01-14     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  339-43     Citation Subset:  IM    
Affiliation:
Department of Respiratory Medicine, Hannover Medical School, Germany. hoeper.marius@mh-hannover.de
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adult
Aged
Exercise Test
Female
Humans
Hypertension, Pulmonary / drug therapy*,  mortality*,  physiopathology
Iloprost / administration & dosage*,  therapeutic use*
Infusions, Intravenous
Male
Middle Aged
Retreatment
Retrospective Studies
Severity of Illness Index
Survival Rate
Treatment Failure
Vasodilator Agents / administration & dosage*,  therapeutic use*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 78919-13-8/Iloprost

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