Pulmonary hypertension unrelated to sepsis and acute respiratory distress syndrome

Epoprostenol and PGE1 allow treatment of pulmonary hypertension of primary or secondary etiology (mitral stenosis, congestive heart failure, and chronic lung disease).

Epoprostenol is more powerful and has a shorter half-life. Within 30 min of cessation of intravenous infusion, most if not all the clinical effects will dissipate ( Sch.e.eie.D...

and Radermacher _199_Z). In patients with primary pulmonary hypertension, epoprostenol is a fundamental element of therapeutic strategy which improves quality of life and survival time, particularly in severely ill patients awaiting transplantation ( Barst etal 1996). In addition to long-term intravenous administration of epoprostenol

(Barst .eta/ 1996), aerosolization of epoprostenol or its stable analog iloprost offers a new strategy for treatment of patients with primary pulmonary hypertension which appears to be more effective than nitric oxide and oxygen therapy ( Oischewskiefa/ 1996).

Extracorporeal circulation

Epoprostenol alone or combined with heparin therapy has been employed to improve platelet count as well as to diminish bleeding complication, during cardiopulmonary bypass, charcoal hemoperfusion, hemodialysis, and hemofiltration ( yane,,an.d,,O.GIa..dy 1993).

During hemodialysis epoprostenol enhances the biological activity of heparin and prevents consumption and activation of platelets without clinically relevant side-effects. During spontaneous and pump-driven hemofiltration, epoprostenol prolongs hemofilter life particularly when combined with low-dose heparin ( Scheeren.,.

and Radermacher.199Z.). In patients with combined acute renal and hepatic failure epoprostenol therapy reduces the episodes of hemorrhage compared with conventional heparin anticoagulation for hemofiltration. Potential hemodynamic side-effects and the dosage of epoprostenol can be reduced by directly infusing into the extracorporeal circuit. A combination of low-dose heparin (5000 IU) and epoprostenol (3-5 ng/kg/min) can be recommended as a safe anticoagulation regimen during hemofiltration in critically ill patients ( S..cheeren.a.n.d R§d§im.§che.Ll99Z).

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