PMID- 12212965
OWN - NLM
STAT- MEDLINE
DCOM- 20030114
LR  - 20190822
IS  - 0903-1936 (Print)
IS  - 0903-1936 (Linking)
VI  - 20
IP  - 2
DP  - 2002 Aug
TI  - Intravenous iloprost for treatment failure of aerosolised iloprost in pulmonary 
      arterial hypertension.
PG  - 339-43
AB  - 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.
FAU - Hoeper, M M
AU  - Hoeper MM
AD  - Department of Respiratory Medicine, Hannover Medical School, Germany. 
      hoeper.marius@mh-hannover.de
FAU - Spiekerkoetter, E
AU  - Spiekerkoetter E
FAU - Westerkamp, V
AU  - Westerkamp V
FAU - Gatzke, R
AU  - Gatzke R
FAU - Fabel, H
AU  - Fabel H
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Respir J
JT  - The European respiratory journal
JID - 8803460
RN  - 0 (Vasodilator Agents)
RN  - JED5K35YGL (Iloprost)
SB  - IM
MH  - Administration, Inhalation
MH  - Adult
MH  - Aged
MH  - Exercise Test
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/*mortality/physiopathology
MH  - Iloprost/*administration & dosage/*therapeutic use
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Retreatment
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Survival Rate
MH  - Treatment Failure
MH  - Vasodilator Agents/*administration & dosage/*therapeutic use
EDAT- 2002/09/06 10:00
MHDA- 2003/01/15 04:00
CRDT- 2002/09/06 10:00
PHST- 2002/09/06 10:00 [pubmed]
PHST- 2003/01/15 04:00 [medline]
PHST- 2002/09/06 10:00 [entrez]
AID - 10.1183/09031936.02.02462001 [doi]
PST - ppublish
SO  - Eur Respir J. 2002 Aug;20(2):339-43. doi: 10.1183/09031936.02.02462001.