Randomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury

Crit Care Med. 2004 Apr;32(4):1055-60. doi: 10.1097/01.ccm.0000120055.52377.bf.

Abstract

Objectives: To investigate whether aerosolized prostacyclin improves oxygenation in children with acute lung injury.

Design: Double-blind, randomized, and placebo-controlled trial.

Setting: Pediatric intensive care unit at a university hospital.

Patients: Fourteen children with acute lung injury defined by the criteria of an American-European Consensus Conference.

Interventions: Aerosolized prostacyclin (epoprostenol sodium) by stepwise increments of different doses (10, 20, 30, 40, and 50 ng x kg x min) vs. aerosolized normal saline (placebo).

Measurements and main results: Before the start of the study, and before and after each dose of prostacyclin/placebo, the following variables were measured: arterial blood gases, heart rate, mean arterial blood pressure, and ventilator settings required. Changes in oxygenation were measured by calculation of the oxygenation index (mean airway pressure x 100 x Pao2/Fio2). After treatment with aerosolized prostacyclin, there was a significant 26% (interquartile range, 3%, 35%) improvement in oxygenation index at 30 ng x kg x min compared with placebo (p =.001). The response to prostacyclin was not the same in all children. We saw an improvement of > or = 20% in eight of 14 children (i.e., responders), and the number needed to treat was 1.8 (95% confidence interval, 1.2-3.2). No adverse effects were observed.

Conclusions: Aerosolized prostacyclin improves oxygenation in children with acute lung injury. Future trials should investigate whether this treatment will positively affect outcome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Aerosols
  • Antihypertensive Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Contusions / drug therapy*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Epoprostenol / administration & dosage*
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Lung Injury*
  • Lung Volume Measurements
  • Male
  • Multiple Trauma / drug therapy*
  • Oxygen / blood
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Adult / drug therapy*

Substances

  • Aerosols
  • Antihypertensive Agents
  • Epoprostenol
  • Oxygen