| Related Articles |
The use of inhaled prostaglandins in patients with acute respiratory distress syndrome: a systematic review and meta-analysis.
Chest. 2015 Mar 5;
Authors: Fuller BM, Mohr NM, Skrupky L, Fowler S, Kollef MH, Carpenter CR
Abstract
Objective: To determine if inhaled prostaglandins are associated with improvement in pulmonary physiology or mortality in patients with ARDS, and to assess adverse effects.
Data Sources: PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, reference lists, conference proceedings, and ClinicalTrials.gov. PROSPERO registration number: CRD42014013180.
Study Selection: Randomized controlled trials (RCTs), and non-randomized studies.
Data Extraction: Two reviewers independently screened titles and abstracts for eligibility.
Data Synthesis: Twenty-five studies (2 RCTs) published over 21 years (1993-2014) were included. One RCT showed no difference in the change in mean PaO2:FiO2 when comparing inhaled alprostadil to placebo, 141.2 (95% CI 120.8-161.5) to 161.5 (95% CI 134.6-188.3) vs. 163.4 (95% CI 140.8-186.0) to 186.8 (95% CI 162.9-210.7), p= 0.21. Meta-analysis of the remaining studies demonstrated that inhaled prostaglandins were associated with improvement in PaO2:FiO2 ratio (16 studies; 39.0% higher, 95% CI 26.7% to 51.3%), and PaO2 (8 studies; 21.4% higher, 95% CI 12.2% to 30.6%), and a decrease in pulmonary artery pressure (-4.8mm Hg; 95% CI -6.8mm Hg to -2.8mm Hg). Risk of bias and heterogeneity were high. Meta-regression found no association with publication year (p = 0.862), baseline oxygenation (p = 0.106), and ARDS etiology (p = 0.816) with the treatment effect. Hypotension occurred in 17.4% of patients in observational studies.
Conclusions: In ARDS, inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures, and may be associated with harm. Data is limited both in terms of methodological quality and demonstration of clinical benefit. The use of inhaled prostaglandins in ARDS needs further study.
PMID: 25742022 [PubMed - as supplied by publisher]