The clinical research is insufficient to support the routine use of inhaled prostacyclin for acute lung injury and acute respiratory distress syndrome in critically ill children or adults with low blood oxygen levels. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical respiratory conditions that are triggered by respiratory viral infections or develop following burns, massive transfusions, multiple trauma, aspiration of gastric contents, pancreatitis, inhalation injury, sepsis, drug overdose and near drowning.
Prostacyclin is a naturally occurring short acting prostaglandin that can improve blood flow and oxygenation in the lungs and reduce inflammation. Prostaglandins are lipid mediators that are derived from essential fatty acids and have important functions. They have important effects on the endothelium of blood vessels, platelets, uterine and mast cells and are found in virtually all tissues and organs. Administration of inhalable prostacyclins requires continuous aerosols over a period of hours to several days, usually during mechanical ventilation. Little of the inhaled prostacyclin reaches the systemic blood circulation although the drug solution may act as a potential irritant due to its very alkaline pH.
We identified one randomized clinical trial with low risk of bias that involved a total of 14 critically ill children with ALI or ARDS. Aerosolized prostacyclin over less than 24 hours did not reduce deaths at 28 days when compared with giving aerosols of saline (a total of three deaths occurred). The authors reported no bleeding or organ dysfunction adverse events. Two trials, one involving adults and the other children, are still to be completed.