Inhaled epoprostenol (iEPO) has been shown to reduce pulmonary artery pressure and improve oxygenation. iEPO is mainly delivered via a syringe pump with feed tubing connected to a vibrating mesh nebulizer with high or low formulation concentration delivery. An in vitro study and a two-period retrospective case–control study were implemented. The in vitro study compared iEPO delivery via invasive ventilation at low concentrations of 7.5, and 15 mcg/mL and high concentration at 30 mcg/mL, to deliver the ordered dose of 30 and 50 ng/kg/min for three clinical scenarios with predicted body weight of 50, 70 and 90 kg. While in the clinical study, adult patients receiving iEPO via invasive ventilation to treat refractory hypoxemia, pulmonary hypertension, or right ventricular failure were included. 80 patients received low concentration iEPO at multiple concentrations (2.5, 7.5, and 15 mcg/mL, depending on the ordered dose) from 2015 to 2017, while 84 patients received high concentration iEPO at 30 mcg/mL from 2018 to 2019. In the in vitro study, there were no significant differences in aerosol deposition between high vs low concentrations of iEPO at a dose of 50 ng/kg/min. In the clinical study, age, gender, ethnicity, and indications for iEPO were similar between high and low concentration groups. After 30–120 min of iEPO administration, both delivery strategies significantly improved oxygenation in hypoxemic patients and reduced mean pulmonary arterial pressure (mPAP) for patients with pulmonary hypertension. However, no significant differences of the incremental changes were found between two delivery groups. Compared to low concentration, high concentration delivery group had better adherence to the iEPO weaning protocol (96% vs 71%, p < 0.001), fewer iEPO syringes utilized per patient (5 [3, 10] vs 12 [6, 22], p = 0.001), and shorter duration of invasive ventilation (6 [3, 12] vs 9 [5, 18] days, p = 0.028). Intensive care unit length of stay and mortality were similar between two groups. Compared to low concentration delivery of iEPO, high concentration iEPO via a vibrating mesh nebulizer maintained clinical benefits and increased clinician compliance with an iEPO weaning protocol, required less medication preparation time, and shortened duration of invasive ventilation.

中文翻译：

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高浓度和低浓度吸入依前列醇与成年插管患者的体外和体内比较

吸入依前列醇 (iEPO) 已被证明可降低肺动脉压并改善氧合。iEPO 主要通过注射泵输送，进料管连接到振动网状雾化器，具有高或低制剂浓度输送。实施了一项体外研究和一项两期回顾性病例对照研究。体外研究比较了通过有创通气在 7.5 和 15 mcg/mL 的低浓度和 30 mcg/mL 的高浓度下通过有创通气递送 iEPO，以在三种临床情况下提供 30 和 50 ng/kg/min 的订购剂量，并预测体重分别为 50、70 和 90 公斤。在临床研究中，纳入了通过有创通气接受 iEPO 治疗顽固性低氧血症、肺动脉高压或右心衰竭的成年患者。从 2015 年到 2017 年，80 名患者接受了多种浓度的低浓度 iEPO（2.5、7.5 和 15 mcg/mL，取决于订购的剂量），而从 2018 年到 2019 年，84 名患者接受了 30 mcg/mL 的高浓度 iEPO。在体外研究中，在 50 ng/kg/min 的剂量下，高浓度和低浓度 iEPO 之间的气溶胶沉积没有显着差异。在临床研究中，高浓度组和低浓度组之间的年龄、性别、种族和 iEPO 适应症相似。在 iEPO 给药 30-120 分钟后，两种给药策略均显着改善了低氧血症患者的氧合，并降低了肺动脉高压患者的平均肺动脉压 (mPAP)。但是，在两个交付组之间没有发现增量更改的显着差异。与低浓度相比，高浓度给药组对 iEPO 撤机方案的依从性更好（96% vs 71%，p < 0.001），每位患者使用的 iEPO 注射器更少（5 [3, 10] vs 12 [6, 22]， p = 0.001），并且有创通气的持续时间更短（6 [3, 12] 对 9 [5, 18] 天，p = 0.028）。两组在重症监护病房的住院时间和死亡率相似。与低浓度 iEPO 给药相比，通过振动网状雾化器的高浓度 iEPO 可保持临床益处并提高临床医生对 iEPO 撤机方案的依从性，需要更少的药物准备时间，并缩短有创通气的持续时间。22]，p = 0.001）和更短的有创通气时间（6 [3, 12] vs 9 [5, 18] 天，p = 0.028）。两组在重症监护病房的住院时间和死亡率相似。与低浓度 iEPO 给药相比，通过振动网状雾化器的高浓度 iEPO 可保持临床益处并提高临床医生对 iEPO 撤机方案的依从性，需要更少的药物准备时间，并缩短有创通气的持续时间。22]，p = 0.001）和更短的有创通气时间（6 [3, 12] vs 9 [5, 18] 天，p = 0.028）。两组在重症监护病房的住院时间和死亡率相似。与低浓度 iEPO 给药相比，通过振动网状雾化器的高浓度 iEPO 可保持临床益处并提高临床医生对 iEPO 撤机方案的依从性，需要更少的药物准备时间，并缩短有创通气的持续时间。