VentaProst (epoprostenol inhalation) / Aerogen Pharma - LARVOL DELTA

A retrospective pilot crossover study of protocolized transition from inhaled nitric oxide to inhaled epoprostenol in adult cardiothoracic surgery. (PubMed, JHLT Open) - "The findings support iEPO as a cost-conscious alternative to iNO in the postoperative setting, with preserved hemodynamic stability and minimal changes in oxygenation. These results contribute to the growing evidence base for implementing standardized iPVD protocols in real-world practice."

Journal • Retrospective data • Cardiovascular • Critical care • Heart Failure • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Breathing Easy: Cases of Transitioning Between Inhaled Prostacyclin Products (SCCM 2026) - "Once optimized, patients are often transitioned back to maintenance medications, however there is minimal to no evidence to guide the transition from nebulized epoprostenol to inhaled treprostinil products.Description: We present 3 patients with PH who were successfully transitioned from nebulized epoprostenol to inhaled treprostinil DPI (Tyvaso DPI®) or nebulizer (Tyvaso®) using multiple approaches. Pulmonologists specialized in PH and pharmacists are uniquely suited to develop treatment plans for transitioning patients between these high-risk medications. Further research and discussion regarding transitions between these inhaled agents would be beneficial to inform patient specific strategies in the future."

Clinical • Cardiovascular • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Outcome of Pediatric Pulmonary Hypertension Patients Requiring ECMO (SCCM 2026) - "100% (31/31) of patients received at least one PAH therapy prior to and during ECMO [31/31 (100%) inhaled nitric oxide or inhaled epoprostenol; 26/31 (84%) sildenafil, tadalafil or riociugat; 18/31 (58%) macitentan, ambrisentan or bosentan; 8/31(26%) selexipag; 10/31(32%) treprostinil. Pediatric PAH is a complex disease due to varied etiologies often requiring multiple medications to effectively manage. Certain subpopulations such as those with single ventricle CHD have higher mortality especially when requiring ECMO. Further study is necessary to determine if earlier identification and management of PAH patients prior to ECMO can improve survival and decrease need for mechanical circulatory support in this high-risk population."

Clinical • Cardiovascular • Heart Failure • Hematological Disorders • Infectious Disease • Pediatrics • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Inhaled Epoprostenol for Refractory Hypoxemia in an Adult Fontan Patient With HLHS: A Case Report (SCCM 2026) - "This case demonstrates the utility of epoprostenol as a rescue strategy for refractory hypoxemia in adults with complex congenital heart disease. Recognition of unique physiologic interactions in this population is crucial for individualized management in the ICU."

Case report • Clinical • Cardiovascular • Cognitive Disorders • Heart Failure • Pulmonary Disease • Respiratory Diseases

Evaluation of Inhaled Epoprostenol Use in the Intensive Care Unit (SCCM 2026) - "Several patients received iEPO for an unapproved indication and many were continued on iEPO despite non-response. This warrants re-evaluation of our approved indications and education regarding iEPO use to reduce time and resources associated with inappropriate use."

Acute Respiratory Distress Syndrome • Cardiovascular • Critical care • Heart Failure • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Fat Embolism Syndrome and Cardiopulmonary Arrest Survival Following Elective Posterior Spinal Fusion (SCCM 2026) - "Max-dose inhaled epoprostenol, antibiotics, inotropes, and diuretics were started...Our case report describes a patient with severe FES and cardiopulmonary collapse following a similarly executed spinal fusion who survived without MCS. This case highlights that, although rare, severe FES is a potential complication of posterior spinal fusions and survival is possible."

Atrial Fibrillation • Cardiovascular • Hematological Disorders • Hepatology • Hypotension • Liver Failure • Musculoskeletal Diseases • Orthopedics • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

IS IT GROUP 3 OR GROUP 1 IN DISGUISE? AN UNTIMELY DIAGNOSIS OF PULMONARY ARTERIAL HYPERTENSION (ACC 2026) - "Despite inhaled epoprostenol, vasopressors, and inotropes, the patient died from right heart failure... Do not assume Group 3 PH in COPD when findings are out of proportion. Obtain a RHC to classify the etiology of PH. Screen for autoimmune causes in suspected PAH and refer early to a PH center."

Cardiovascular • Chronic Obstructive Pulmonary Disease • Congestive Heart Failure • Heart Failure • Immunology • Peripheral Arterial Disease • Pulmonary Arterial Hypertension • Respiratory Diseases • Scleroderma • Systemic Sclerosis

PULMONARY ARTERIAL HYPERTENSION MIMIC: PULMONARY TUMOR THROMBOTIC MICROANGIOPATHY IN METASTATIC ENDOMETRIAL CARCINOMA (ACC 2026) - "Case: A 58-year-old female with diabetes, hypertension, and prior breast cancer on tamoxifen presented with weight loss and post-menopausal bleeding...She received norepinephrine, vasopressin, inhaled epoprostenol, and IV prostacycline but deteriorated and expired... Early suspicion and diagnosis of PTTM are essential to guide care, though prognosis remains poor."

Metastases • Breast Cancer • Cardiovascular • Diabetes • Endometrial Adenocarcinoma • Endometrial Cancer • Gynecology • Hypertension • Hypotension • Lung Cancer • Metabolic Disorders • Oncology • Pulmonary Arterial Hypertension • Respiratory Diseases • Solid Tumor

ACUTE RV SHOCK AFTER TRANSCATHETER TRICUSPID VALVE REPLACEMENT (ACC 2026) - "Inhaled epoprostenol (50 ng/kg/min) was added to decrease PVR...Intermittent IV bumetanide was used to achieve a CVP of 10-12 mmHg... The patient improved clinically and hemodynamically. After 36 hours of hemodynamic stability, vasoactive agents were weaned in sequence—vasopressin, then dobutamine, followed by epoprostenol. All vasoactives were off by post-procedure day 4 and the patient was discharged by day 6."

Cardiovascular • Metabolic Disorders • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Management of Pulmonary Hypertension Due to Atrial Septal Defect and Acute Pulmonary Embolism with VA-ECMO (ISHLT 2026) - "She received diuretics, inhaled epoprostenol, and anti-coagulation, and was extubated day 9...IV treprostinil was started up to 20 ng/kg/min allowing for ECMO decannulation on day 25.She was transitioned to oral PH therapy (macitentan/sildenafil) with ASD closure deferred due to high PVR...She is now off oxygen, working, on combination pill macitentan/tadalafil.Summary VA-ECMO is a viable strategy for PH patients who develop refractory RV failure, as a bridge to lung transplantation or initiation of PH therapies. Careful patient selection and multidisciplinary management is essential."

Cardiovascular • Hypertension • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Thrombosis

Use of Inhaled Epoprostenol to Facilitate Ventilator Weaning in Scleroderma-Associated Group 1 Pulmonary Arterial Hypertension and Acute Right Heart Failure (ATS 2026) - No abstract available

Cardiovascular • Congestive Heart Failure • Heart Failure • Immunology • Pulmonary Arterial Hypertension • Respiratory Diseases • Scleroderma • Systemic Sclerosis

Substantial Cost Savings: A Multi-Center Cost Analysis of Nitric Oxide and Epoprostenol Usage in Neonatal Congenital Heart Disease (STS 2026) - "Conclusions In neonatal congenital heart cases, NO is used almost universally despite little clinical difference to inhaled epoprostenol. Because NO is around 32 times more expensive than epoprostenol, strategic implementation of epoprostenol as an alternative to NO could yield substantial cost savings while maintaining therapeutic efficacy. Table Image"

Clinical • Cost-analysis • HEOR • Cardiovascular • Heart Failure

Between a Rock and a Hard Place: Hip Fracture Repair in an Elderly Patient with Severe Cardiac Comorbidities and Limited Options: A Problem-Based Learning Discussion. (PubMed, A A Pract) - "A tailored management approach included peripheral nerve blocks, intraoperative transesophageal echocardiographic monitoring, goal-directed hemodynamic support, and management of acute RV decompensation with intratracheal milrinone and inhaled epoprostenol. It presents strategies for high-risk geriatric trauma patients, individualized anesthetic planning, and the role of pulmonary vasodilators."

Journal • Anesthesia • Cardiovascular • Cognitive Disorders • Geriatric Disorders • Heart Failure • Hypertension • Musculoskeletal Diseases • Orthopedics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

One and Done: Simplifying Inhaled Epoprostenol with Single-Syringe Workflow (ASHP 2025) - No abstract available

Impact of a Weaning Protocol on Duration of Inhaled Epoprostenol Therapy in Acute Respiratory Distress Syndrome: A Retrospective Review (ASHP 2025) - No abstract available

Retrospective data • Review • Acute Respiratory Distress Syndrome • Respiratory Diseases

Inhaled Epoprostenol Augments Cold-Induced Vasodilation: A Double-Blind Crossover Trial. (PubMed, Wilderness Environ Med) - "No hypotension, hypothermia, or hypoxia was observed, and no subject requested discontinuation due to side effects.ConclusionIn this small study, inhaled epoprostenol induced a statistically significant increase in mean temperature, mean maxima temperature, and mean minima temperature in fingers immersed in a cold-water bath, consistent with an augmented CIVD response. The ability to deliver an inhaled PGI2 analog via nebulizer raises the possibility of early interventions to manage frostbite in austere environments, but further study is needed to draw any conclusions regarding the use of epoprostenol for frostbite care."

Journal • Hypotension

Partial Anomalous Pulmonary Venous Return: An Uncommon Cause of Refractory Hypoxemia Following Coronary Artery Bypass Grafting (AHA 2025) - "Treatment with milrinone, inhaled nitric oxide, and inhaled epoprostenol led to significant hemodynamic and oxygenation improvement. PAPVR, though rare, should be a part of differential diagnosis in persistent hypoxemia and right ventricular dysfunction after CABG. Early recognition through multimodal imaging, including CT and TEE, is critical. ECMO may be necessary for stabilization while pursuing definitive surgical management."

Cardiovascular • Coronary Artery Disease • Diabetes • Gastroenterology • Gastroesophageal Reflux Disease • Genetic Disorders • Heart Failure • Metabolic Disorders • Myocardial Infarction • Obesity • Pulmonary Disease • Respiratory Diseases

FALSELY ELEVATED PANEL REACTIVE ANTIBODIES IN A CRITICALLY ILL LUNG TRANSPLANT CANDIDATE: SAFELY CROSSING ENEMY LINES (CHEST 2025) - "At listing, his LT window was narrow as he required high- flow nasal cannula and inhaled epoprostenol and was not a candidate for intubation or ECMO bridging due to advanced age...He was given a dose of IVIG and standard induction with basiliximab and 3-drug immunosuppression with mycophenolate mofetil, prednisone, and tacrolimus. Our patient underwent a successful and life-saving LT across a strongly positive T and B cell virtual crossmatch, the results of which were negated based upon prior surrogate crossmatch testing."

Idiopathic Pulmonary Fibrosis • Immunology • Infectious Disease • Influenza • Novel Coronavirus Disease • Pulmonary Disease • Respiratory Diseases • Transplantation • HLA-C

PULMONARY-RENAL SYNDROME IN ANCA-ASSOCIATED VASCULITIS: A CASE OF DIFFUSE ALVEOLAR HEMORRHAGE AND ACUTE HYPOXIC RESPIRATORY FAILURE (CHEST 2025) - "She was started on BiPAP and empiric antibiotics for suspected pneumonia.She deteriorated, developing severe ARDS requiring intubation, paralysis, and inhaled epoprostenol. This case highlights the importance of early recognition of ANCA-associated vasculitis in patients with pulmonary-renal syndrome, where timely intervention with plasma exchange and immunosuppressive therapy can significantly improve outcomes."

Clinical • Acute Respiratory Distress Syndrome • ANCA Vasculitis • Anemia • Bronchiectasis • Cardiovascular • Chronic Kidney Disease • Glomerulonephritis • Hematological Disorders • Hypertension • Infectious Disease • Lupus Nephritis • Musculoskeletal Diseases • Musculoskeletal Pain • Nephrology • Orthopedics • Otorhinolaryngology • Pneumonia • Pulmonary Disease • Renal Disease • Respiratory Diseases • Sinusitis • Vasculitis

ECMO AS A BRIDGE TO INITIATING THERAPY IN PULMONARY HYPERTENSION: A CASE REPORT (CHEST 2025) - "While there, the patient was started on inhaled epoprostenol and required multiple vasopressors...However, the patient was able to be supported through ECMO while intravenous epoprostenol, sildenafil, and inhaled nitric oxide were titrated with improvement in her pulmonary artery pressures... In conclusion, this case demonstrates the importance of minimizing delays in diagnosis of pulmonary hypertension and also adds to the sparse literature about the utility of ECMO as a bridge to definitive pulmonary hypertension therapy."

Case report • Clinical • Cardiovascular • Gynecology • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Urinary Incontinence • Urology

SEVERE ARDS CAUSED BY MYCOPLASMA PNEUMONIAE INFECTION IN A PATIENT RECEIVING ANIFROLUMAB (CHEST 2025) - "She was previously on methotrexate for SLE but had been recently transitioned to Anifrolumab three weeks prior to admission...Inhaled epoprostenol was initiated and antibiotics were broadened... In summary, our case may represent a sentinel instance of an Anifrolumab-associated increased pathogenicity of a common, modestly pathogenic organism. Such increased pathogenicity may be drug-specific and result in ARDS by inhibiting the putative type I interferon pathway. Its immunosuppressive properties may further complicate the treatment of these diseases."

Clinical • Acute Respiratory Distress Syndrome • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Influenza • Lupus • Novel Coronavirus Disease • Pneumonia • Scleroderma • Systemic Lupus Erythematosus • Systemic Sclerosis • IFNA1 • IFNAR1 • IFNAR2 • IFNB1

RHEUMATIC HEART DISEASE: A FORGOTTEN STRUGGLE IN MODERN MEDICINE (CHEST 2025) - "She was managed with beta blockers, diuresis and inhaled epoprostenol, and was eventually transferred to a tertiary care hospital where she underwent balloon mitral valvuloplasty with complete resolution of symptoms. This case report exemplifies that despite the decreased incidence of RHD in developed countries, valvular heart disease should remain on the differential for female patients in the age of 20-50 presenting with shortness of breath in setting of past history of rheumatic fever."

Acute Respiratory Distress Syndrome • Asthma • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Cough • Heart Failure • Immunology • Infectious Disease • Inflammation • Novel Coronavirus Disease • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

PALLIATIVE LOBECTOMY FOR PERSISTENT HYPOXEMIA IN NON-SMALL CELL LUNG CANCER (CHEST 2025) - "Inhaled epoprostenol provided minimal improvement in her symptoms... Even in patients with metastatic disease where surgical intervention provides no malignancy-related survival benefit, clinicians should consider palliative indications for surgical intervention. Our patient was able to derive significant quality of life benefit from improvement in hypoxemia following right lower lobectomy."

Fatigue • Infectious Disease • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Pneumonia • Pulmonary Disease • Respiratory Diseases • Solid Tumor

FROM SLEEP CLINIC TO THE UNIT: POST-TONSILLECTOMY HEMORRHAGE WITH ACUTE RESPIRATORY DISTRESS SYNDROME REQUIRING VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION (VV ECMO) (CHEST 2025) - "Bronchoscopy with therapeutic aspiration of copious bloody secretions was performed however, SpO2 did not improve and the patient continued to require high positive end expiratory pressure (PEEP) and 100% FiO2, even with the addition of neuromuscular blockade (NMB) and inhaled epoprostenol... Even though adult tonsillectomy is a common ambulatory procedure there remains an 11.9% risk of PTH in which a dangerous cascade can lead to ARDS. In extreme cases of OSA where the condition is refractory to BPAP, keeping patients intubated for sedation weaning and extubation in the ICU should be considered."

Acute Respiratory Distress Syndrome • Anesthesia • CNS Disorders • Hematological Disorders • Inflammation • Obstructive Sleep Apnea • Pneumonia • Respiratory Diseases • Sleep Disorder

OH BABY! A CURIOUS CASE OF A GRAVID PATIENT WITH ARDS REQUIRING ECMO AND EMERGENT CESARIAN SECTION (CHEST 2025) - "Pronation and inhaled epoprostenol was initiated due to ongoing ventilator requirements... While viral infections are typically treated with supportive measures, physiologic changes in pregnancy can put gravid patients at risk of developing critical illness. While ARDS protocol remains largely the same, with the caveat of targeting a goal SpO2 of 95% or greater for fetal well-being. Interprofessional collaboration with obstetrics should be a priority to assist with monitoring fetal heart tracings and timing of delivery."

Clinical • Acute Respiratory Distress Syndrome • Infectious Disease • Novel Coronavirus Disease • Obstetrics • Respiratory Diseases