An evaluation of nebulized prostacyclin in patients with primary and secondary pulmonary hypertension

Aims To investigate the response to inhaled prostacyclin in patients with primary and secondary pulmonary hypertension and to compare its effects to those of intravenous prostacyclin and inhaled nitric oxide. Methods and results Twelve patients with pulmonary hypertension (seven primary and five secondary) were studied. All patients had a pulmonary artery balloon flotation catheter inserted into the proximal pulmonary artery and radial arterial line. Prostacyclin was nebulized with 81.min(-1) of oxygen and administered in doses increasing from 15 to 50 ng.kg(-1), min(-1) via a fatemask. Eight of these patients also received intravenous prostacyclin in doses of 1 to 5 ng.kg(-1).min(-1) and nitric oxide in doses of 10 to 100 ppm via a facemask. Haemodynamic measurements were taken during each treatment. In the 12 patients, nebulized prostacyclin produced a significant reduction in mean pulmonary artery pressure from 56+/-5 to 45+/-4 mmHg (P=0.0001). The pulmonary vascular resistance decreased by 38% from 964+/-169 to 595+/-116 dyne.s(-1).cm(-5) (P=0.0001). Direct comparison with inhaled nitric oxide and intravenous prostacyclin in eight patients demonstrated that nebulized prostacyclin produced a greater fall in mean pulmonary artery pressure than the other two agents without any significant effect on systemic arterial pressure. Conclusion Nebulized prostacyclin appears to be more effective at reducing pulmonary artery pressure in patients with pulmonary hypertension when compared to intravenous prostacyclin and inhaled nitric oxide. This could have important clinical implications for the management of patients with pulmonary hypertension.