Inhaled Epoprostenol in Children With Pediatric Acute Respiratory Distress Syndrome: A Single-Center Retrospective Study

Background Inhaled epoprostenol (iEpo) may improve oxygenation in adults with hypoxic respiratory failure, but any effect in children with pediatric acute respiratory distress syndrome (pARDS) is unknown. Methods Retrospective observational cohort study 2017-2022 at a single pediatric intensive care unit (PICU) of children who met criteria for pARDS and received iEpo for >= 6 h. Results 18 children were included, with a median age of 2.9 years (IQR 1.4-7.9), severe pARDS in 14/18 (78%), and pulmonary hypertension in 8/18 (44%). Median OSI immediately pre-iEpo initiation was 22.9 (IQR 16.1-27.3), at 6 h was 16.8 (IQR 12.6-27.5, p = 0.57 vs. pre-initiation) and at 12 h was 15.1 (IQR 10.7-27.5, p = 0.48 vs. pre-initiation). Discontinuity regression demonstrated a change in the slope (rate of change) of OSI from increasing slope of +0.60/hr to decreasing slope of -1.38/hour in the 12 h pre- versus post- iEpo initiation (p < 0.001). At 6 h after iEpo initiation, most patients (12/18, 67%) had a decrease in OSI and 5/18 (28%) were responders with a decrease of >= 20%. Responders did not differ significantly by presence of pulmonary hypertension, severity of pARDS, or age. The majority of responders (4/5, 80%) had improvement in OSI by 1 h after initiation of iEpo and all (5/5, 100%) had improvement by 4 h after iEpo initiation. Conclusion Rate of change of OSI improved significantly after initiation of iEpo in a cohort children with pARDS, with heterogeneity of response that was not associated with pHTN or other clinical factors evaluated. Improvement in OSI was seen by 4 h in all responders.