TY - JOUR
T1 - The use of inhaled prostaglandins in patients with ARDS
T2 - A systematic review and meta-analysis
AU - Fuller, Brian M.
AU - Mohr, Nicholas M.
AU - Skrupky, Lee
AU - Fowler, Susan
AU - Kollef, Marin H.
AU - Carpenter, Christopher R.
N1 - Publisher Copyright:
© 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - OBJECTIVE: This study aimed to determine whether inhaled prostaglandins are associated with improvement in pulmonary physiology or mortality in patients with ARDS and assess adverse effects. METHODS: The following data sources were used: PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, reference lists, conference proceedings, and ClinicalTrials.gov. Studies selected included randomized controlled trials and nonrandomized studies. For data extraction, two reviewers independently screened titles and abstracts for eligibility. With regard to data synthesis, 25 studies (two RCTs) published over 21 years (1993-2014) were included. The PROSPERO registration number was CRD42014013180. RESULTS: One randomized controlled trial showed no difference in the change in mean PaO2 to FIO2 ratio when comparing inhaled alprostadil to placebo: 141.2 (95% CI, 120.8-161.5) to 161.5 (95% CI, 134.6-188.3) vs 163.4 (95% CI, 140.8-186.0) to 186.8 (95% CI, 162.9-210.7), P = .21. Meta-analysis of the remaining studies demonstrated that inhaled prostaglandins were associated with improvement in PaO2 to FIO2 ratio (16 studies; 39.0% higher; 95% CI, 26.7%-51.3%), and PaO2 (eight studies; 21.4% higher; 95% CI, 12.2%-30.6%), and a decrease in pulmonary artery pressure (-4.8 mm Hg; 95% CI, -6.8 mm Hg to -2.8 mm Hg). Risk of bias and heterogeneity were high. Meta-regression found no association with publication year (P = .862), baseline oxygenation (P = .106), and ARDS etiology (P = .816) with the treatment effect. Hypotension occurred in 17.4% of patients in observational studies. CONCLUSIONS: In ARDS, inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures and may be associated with harm. Data are limited both in terms of methodologic quality and demonstration of clinical benefit. The use of inhaled prostaglandins in ARDS needs further study.
AB - OBJECTIVE: This study aimed to determine whether inhaled prostaglandins are associated with improvement in pulmonary physiology or mortality in patients with ARDS and assess adverse effects. METHODS: The following data sources were used: PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, reference lists, conference proceedings, and ClinicalTrials.gov. Studies selected included randomized controlled trials and nonrandomized studies. For data extraction, two reviewers independently screened titles and abstracts for eligibility. With regard to data synthesis, 25 studies (two RCTs) published over 21 years (1993-2014) were included. The PROSPERO registration number was CRD42014013180. RESULTS: One randomized controlled trial showed no difference in the change in mean PaO2 to FIO2 ratio when comparing inhaled alprostadil to placebo: 141.2 (95% CI, 120.8-161.5) to 161.5 (95% CI, 134.6-188.3) vs 163.4 (95% CI, 140.8-186.0) to 186.8 (95% CI, 162.9-210.7), P = .21. Meta-analysis of the remaining studies demonstrated that inhaled prostaglandins were associated with improvement in PaO2 to FIO2 ratio (16 studies; 39.0% higher; 95% CI, 26.7%-51.3%), and PaO2 (eight studies; 21.4% higher; 95% CI, 12.2%-30.6%), and a decrease in pulmonary artery pressure (-4.8 mm Hg; 95% CI, -6.8 mm Hg to -2.8 mm Hg). Risk of bias and heterogeneity were high. Meta-regression found no association with publication year (P = .862), baseline oxygenation (P = .106), and ARDS etiology (P = .816) with the treatment effect. Hypotension occurred in 17.4% of patients in observational studies. CONCLUSIONS: In ARDS, inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures and may be associated with harm. Data are limited both in terms of methodologic quality and demonstration of clinical benefit. The use of inhaled prostaglandins in ARDS needs further study.
UR - http://www.scopus.com/inward/record.url?scp=84930890674&partnerID=8YFLogxK
U2 - 10.1378/chest.14-3161
DO - 10.1378/chest.14-3161
M3 - Article
C2 - 25742022
AN - SCOPUS:84930890674
SN - 0012-3692
VL - 147
SP - 1510
EP - 1522
JO - CHEST
JF - CHEST
IS - 6
ER -