Faculty Children's Hospital of Atlanta Brookhaven, Georgia, United States
Abstract: Introduction The use of continuous Prostanoid as a therapy in critically ill pediatric patients with pulmonary arterial hypertension (PAH) has increased over the recent years, however, very limited data exists regarding Prostanoid (PG) use in the pediatric cardiac intensive care unit (CICU) setting. Methods We performed a single center, retrospective chart review of all patients admitted to our pediatric CICU from January 2015 to April 2022 in whom continuous PG therapy was initiated. Data collected included demographics, diagnosis, vasoactive use, ventilation strategy, length of stay, and survival. Etiology and degree of PAH was recorded. Type, initial dose, maximum dose, and final dose of PG was collected, and the hemodynamic impact of the PG recorded. Data reported as mean ± standard deviation. Significance was a p-value of < 0.05. Results Twenty-five patients had PG therapy initiated at a mean age of 3.3 years, range (0 to 16.6 years). PG was in the form of IV Epoprostenol 12 patients, IV Treprostinil in 6, and Sub Q Treprostinil in 6 patients. Inhaled Epoprostenol initiated in 1 patient. The mean initial dose was 4.68 ng/kg/min, mean max dose of 20 ng/kg/min, average duration of therapy in the CICU was 37 days. At PG initiation, 22 (88%) of patients were on vasoactive infusions, 20 (80%) were receiving mechanical ventilation, and 6 (24%) were on extracorporeal membrane oxygenation (ECMO) support. PG initiation was well tolerated in 14 (56%) patients, 8 (32%) patients had PG discontinued due to hypotension. Sub Q Treprostinil was well tolerated hemodynamically in all 6 patients. There was a 40% (n=10) in-hospital mortality rate, with mechanical ventilation and ECMO support being risk factors for death (p=0.04, and 0.01 respectively). Conclusion PG initiation and continued therapy was well tolerated in approximately 50% of this CICU cohort. Side effects were common, with hypotension resulting in discontinuation in 1/3rd of patients. Sub Q Treprostinil was the better tolerated drug. Ongoing evaluation of the benefits of PG for patients in the CICU setting will help identify patient selection, type, and dosing of PG for our patient population exhibiting severe PAH.
