OVERUSE OF AEROSOLIZED PROSTACYCLIN IN THE MANAGEMENT OF ARDS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Prone ventilation is often under-utilized in the management of acute respiratory distress syndrome (ARDS). One potential reason could be due to use of aerosolized prostacyclin which is known to improve the oxygenation status. As a result of improved oxygenation, clinicians may delay other treatment modalities such as proning which has been associated with both improved oxygenation and mortality. Therefore, we aimed to look at our institutions’ use of aerosolized prostacyclin in patients who might be eligible for proning instead. METHODS: We performed a retrospective chart review of patients admitted to the medical intensive care unit (MICU) between 2016 and 2018 for ARDS using the Berlin definition. We enrolled patients only if they were on mechanical ventilation for = 48 hours. We collected the following data: age, gender, body mass index (BMI), PaO2/FiO2 (P/F) ratios on days 1-3, comorbidities, aerosolized prostacyclin use and adjunctive therapies (proning, neuromuscular blockade). We defined patients with BMI = 36 kg/m2 and P/F = 150 as those eligible for proning. RESULTS: Eighty six patients with ARDS were identified of which 41 (48%) received aerosolized prostacyclin. On day 1, twenty four patients had P/F = 150. Amongst this group, 13 (54%) patients eligible for proning continued to receive prostacyclin instead. On day 2, four (31%) out of the 13 patients had P/F = 150 but were not proned. Overall, aerosolized prostacyclin was used in 52% of patients in 2016, 65% of patients in 2017 and 30% of patients in 2018. CONCLUSIONS: We found that aerosolized prostacyclin was administered frequently in managing patients with severe ARDS and proning was under-utilized. This could be due to three reasons: transient improvement in oxygenation after starting prostacyclin therapy thus discouraging the clinician to consider proning, patient’s body habitus and the laborious nature of prone positioning. The reduction in prostacyclin over the 3-year study period use could be due to increased awareness of adjunctive measures for ARDS. Our study did not account for contraindications to proning such as spinal instability, unstable fractures, burns and high intra-cranial pressure; however, at our institution such patients are admitted to the surgical ICU. The major limitations of our study are its small sample size and retrospective methodology. Therefore, the generalizability is limited. In summary, aerosolized prostacyclin use in ARDS treatment continues to remain high. CLINICAL IMPLICATIONS: Overuse of nebulized prostacyclin may lead to under utilization of proning due to the transient improvement of hypoxemia seen with prostacyclin use in the management of ARDS. DISCLOSURES: No relevant relationships by Ryan Hyde, source=Web Response No relevant relationships by Johnny Jaber, source=Web Response No relevant relationships by Saminder Kalra, source=Web Response No relevant relationships by Sarina Parikh, source=Web Response No relevant relationships by Raju Reddy, source=Web Response No relevant relationships by Daniel Urbine, source=Web Response