VentaProst (epoprostenol inhalation) / Aerogen Pharma - LARVOL DELTA

Inhaled Epoprostenol for Management of Acute Respiratory Failure and Pulmonary Vascular Disease. (PubMed, Pulm Pharmacol Ther) - "However, it may be beneficial in certain select patient populations. In the management of pulmonary hypertension, inhaled epoprostenol has allowed for continued maintenance of chronic pulmonary arterial hypertension-specific therapy and for possibly improving right ventricular function as an attractive option in the critical care management of pulmonary hypertension."

Journal • Review • Acute Respiratory Distress Syndrome • Cardiovascular • Critical care • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Maternal Pulmonary Arterial Hypertension Treated With IV Epoprostenol - A Case Report (ATS 2025) - "Her pre-gestation medications included Ambrisentan, Selexipag, and Sildenafil...The patient was then transitioned from IV Epoprostenol to inhaled Treprostinil via dry powder inhaler...IV Epoprostenol may be used adjunctively in the management of pregnant PAH patients and could improve peri and postpartum outcomes. This case adds to a growing literature base on this subject; the difficulties of performing a blinded, randomized clinical trial in this cohort are acknowledged."

Case report • Clinical • Cardiovascular • Pulmonary Arterial Hypertension • Respiratory Diseases

A Rare Case of Antisynthetase Syndrome and Rapidly Progressive Interstitial Lung Disease (ATS 2025) - "The patient required veno-venous ECMO despite proning and inhaled epoprostenol. Treatments included high-dose methylprednisolone, cyclophosphamide, plasmapheresis, IVIG, tofacitinib, tacrolimus, and mycophenolate mofetil...RP-ILD, which may lead to significant morbidity or fatal outcomes, presents notable treatment challenges with limited options and high associated mortality rates. This case underscores the importance of suspecting ASyS in isolated ILD diagnoses especially in high-risk populations."

Clinical • Acute Respiratory Distress Syndrome • Asthma • Eosinophilia • Immunology • Interstitial Lung Disease • Myositis • Obstructive Sleep Apnea • Pulmonary Disease • Rare Diseases • Respiratory Diseases • Rheumatology • Sarcopenia • Sleep Disorder

Rapid Respiratory Compromise Secondary to Atypical Bacterial Pneumonia Leading to Multiorgan Failure and Profound Refractory Shock (ATS 2025) - "Subsequently, patient developed profound shock and hypoxia requiring inhaled epoprostenol, paralysis, and proning...Antibiotics were deescalated to penicillin G, clindamycin, and oseltamivir with the addition of IVIG, steroids, and multiple pressors including methylene blue due to concerns for necrotizing pneumonia and toxic shock syndrome...Additionally, the significant mortality rate associated with invasive disease warrants further discussion into additional treatment modalities and early recognition of this pathogen to aid in the cessation of disease progression to multiorgan failure due to toxic shock syndrome. This case aims to highlight a case of a young individual with no comorbid conditions who rapidly progressed despite maximal therapies and focuses on the importance of early recognition in an atypical patient population."

Dermatology • Hematological Disorders • Hematological Malignancies • Human Immunodeficiency Virus • Infectious Disease • Influenza • Leukemia • Metabolic Disorders • Neutropenia • Oncology • Pneumonia • Respiratory Diseases • Septic Shock

Pre LVAD Implantation Assessment Using Right Ventricular - Arterial Coupling Predicts Immediate Right Heart Failure and Need for RVAD (ISHLT 2025) - "Early post-operative RHF was defined as a cumulative outcome including the need for RVAD, inhaled epoprostenol > 48 hours, or inotropic support >14 days.Results 146 patients underwent LVAD implant at our institution between 2019 and 2024 (Figure 1)...TTE derived RV-PA coupling was decreased in patients requiring RVAD (median: 0.26 vs 0.17, P=0.003) and who developed RHF (median: 0.33 vs 0.24, P=0.016). Peri-operative TEE RV FW strain < -9.5% was predictive of all-cause mortality (P=0.034) post LVAD implant, but TTE derived metrics did not show significant predictive value.Conclusion Pre-LVAD implantation decreased RV FW strain, and RV-PA coupling can aid with the risk stratification of patients in need of RVAD or immediate RHF."

Cardiovascular • Congestive Heart Failure • Heart Failure • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Thymoglobulin Use as Induction for Positive Crossmatch in the Absence of HLA DSA: Impact of Non-HLA DSA in Lung Transplant (ISHLT 2025) - "Both received intra-op basiliximab induction immunosuppression (IS) followed by per protocol maintenance IS...Induction IS was changed to rabbit anti-thymocyte globulin (rATG) on post-operative day (POD) 1 and 3 for P1 and P2, respectively...P1 required high dose pressors and inhaled epoprostenol post-transplant, and P2 required early re-intubation for ventilatory support...Induction with rATG may help mitigate non-HLA Ab-induced allograft injury. Further studies are needed to elucidate ideal management of positive XM due to non-HLA Ab."

Infectious Disease • Transplantation

Chlorine gas induced acute respiratory distress syndrome due to pool shock. (PubMed, Am J Emerg Med) - "He was rapidly intubated, received bronchodilators, intravenous dexamethasone and inhaled epoprostenol, and underwent prone positioning. Targeted therapy for chlorine gas induced lung injury is limited. Despite a rapid decline over his initial clinical course, and prognostic markers all portending a poor outcome, aggressive management of his lung injury with standard ARDS care proved to be effective, and the patient made an excellent recovery."

Journal • Acute Respiratory Distress Syndrome • Conjunctivitis • Ocular Infections • Ocular Inflammation • Ophthalmology • Pulmonary Disease • Respiratory Diseases

MANAGEMENT OF RIGHT HEART FAILURE IN COMBINED PRE AND POST-CAPILLARY PULMONARY HYPERTENSION AFTER LEFT VENTRICULAR ASSIST DEVICE PLACEMENT - Shyla McMurtry (ACC 2025) - "While CI and PCWP improved with nitroprusside (CI 2.2 -2.3; PCWP 7), PVR remained elevated at 6 WU. Treated as combined pre- and post-capillary PH with sildenafil and selexipag followed by BiVAD placement...LVAD settings at before inhaled epoprostenol (iNO) at speed 5000 rpm, flow 4.0 lpm, pulsatility index (PI) 4.0, and power of 3.3W. Repeat RHC showed mixed etiology PH (RA 23, RV 51/14, PA 59/29, PCWP 19) and continued elevated PVR to 6WU, thus started on sildenafil and iNO along with pre-existent milrinone... While studies are needed to evaluate using PAH medications in WHO group 2 PH, we highlight their use in managing right heart failure during LVAD placement."

Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

WHEN THE LUNGS BREAK THE RULES: A RARE CASE OF ESOPHAGEAL VARICEAL BLEED IN NON-CIRRHOTIC PORTAL HYPERTENSION DRIVEN BY PULMONARY ARTERIAL HYPERTENSION - Ajay Kerai (ACC 2025) - "Extensive rheumatologic workup, hypercoagulability testing, and testing for common variable immunodeficiency, were all negative.Decision-making: Due to concern for acute on chronic cor pulmonale secondary to severe PAH, the patient was initiated on dobutamine for right ventricular support and underwent aggressive diuresis. Pulmonary vasodilator therapy was initiated with inhaled epoprostenol, which was later transitioned to intravenous epoprostenol, anticipating longterm management of PAH... Severe PAH can cause non-cirrhotic portal hypertension, leading to esophageal variceal bleeding. Treating PAH and managing cor pulmonale are essential to prevent further complications like secondary cirrhosis and recurrent varices."

Clinical • Cardiovascular • Fibrosis • Hepatology • Hypotension • Immunology • Metabolic Disorders • Portal Hypertension • Primary Immunodeficiency • Pulmonary Arterial Hypertension • Pulmonary Embolism • Respiratory Diseases • Rheumatology

TUMORAL PULMONARY HYPERTENSION SECONDARY TO GI MALIGNANCY - Rachel Wester (ACC 2025) - "She was started on milrinone and inhaled epoprostenol and transitioned to IV treprostinil and oral sildenafil. The precise mechanism of PH in patients with malignancy remains to be explored. Histopathological diagnosis with tissue sampling is the gold standard. The optimal management of PTTM is unclear but prior case reports discuss supportive care, chemotherapy, steroids, oxygen and PAH medications."

Cardiovascular • Gastrointestinal Cancer • Hematological Disorders • Lung Cancer • Oncology • Pulmonary Arterial Hypertension • Pulmonary Disease • Rare Diseases • Respiratory Diseases • Thrombocytopenia

A CASE OF FATAL RECALCITRANT POLYMORPHIC VENTRICULAR TACHYCARDIA STORM POST-LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: LESSONS LEARNED - Dhruvi Patel (ACC 2025) - "On day 26, he began manifesting recurrent episodes of new onset sustained VT requiring multiple direct current cardioversions.Decision-making: Patient failed Amiodarone...Mexiletine and quinidine did not suppress VT. Right ventricular function was supported with inhaled epoprostenol and low dose dobutamine... Optimal management of VT storm post-LVAD is challenging. The only identified risk factor for VT in our case was stage 3b renal failure. This case highlights high morbidity and mortality in this challenging population and need for a rapid algorithmic approach."

Clinical • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Congestive Heart Failure • Coronary Artery Disease • Epilepsy • Heart Failure • Nephrology • Renal Disease • Ventricular Tachycardia

The Use of Inhaled Epoprostenol in Severe Hypoxemia and Biventricular Failure from Stress-Induced Cardiomyopathy following Subarachnoid Hemorrhage (IARS-SOCCA 2025) - "Epoprostenol has shown to improve outcomes in cases of hypoxemia due to aneurysmal SAH by addressing pulmonary complications that exacerbate morbidity and mortality​3​. Management of acute hypoxemia from SAH focuses on improving oxygenation and decreasing intracranial pressure (ICP) without reducing systolic blood pressure. As a potent pulmonary vasodilator, epoprostenol selectively acts to improve oxygenation and mitigate ventilation-perfusion mismatch while preserving cerebral perfusion pressure​4​."

Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Heart Failure • Hematological Disorders • Hypotension • Respiratory Diseases • Subarachnoid Hemorrhage

No stone unturned: Transport and management considerations of hypoxia and persistent hypotension following arrest in a cardiac transplant recipient (IARS-SOCCA 2025) - "To address the patient's shock, epinephrine and vasopressin were initiated prior to transport, inhaled epoprostenol was recommended but not available, and our facility began preparations for mechanical thrombectomy...Right heart catheter (RHC) revealed cardiac output of 5.68 L/min and SVR of 915 Dynes.sec/cm5 and dobutamine was begun...Hydroxocobalamin was added for vasoplegia...Ultimately, infectious workup revealed COVID-19 and MSSA pneumonia for which he received dexamethasone, remdesivir, and an appropriate antibiotic course...This case highlights altitude physiology considerations for patients who require high FiO2 prior to transport, as well as the need to thoroughly evaluate and treat patients with shock for each possible category: distributive, hypovolemic, cardiogenic, and obstructive. Our patient's presumed etiology was initially obstructive give his massive pulmonary embolism, but ongoing therapy for this did not resolve his shock state. Moderate RV..."

Clinical • Cardiovascular • Hypotension • Infectious Disease • Novel Coronavirus Disease • Pneumonia • Pulmonary Embolism • Respiratory Diseases • Transplantation

Hypoxic respiratory failure from diaphragm paralysis status post 1st rib resection diagnosed by POCUS: A Case Report (IARS-SOCCA 2025) - "The patient was empirically treated for community acquired pneumonia while re-expansion of his collapsed right lower lobe was pursued with two 16-hour proning sessions and ventilation/perfusion optimization was attempted with inhaled epoprostenol...First rib resection for thoracic outlet syndrome carries a relatively low risk of unilateral diaphragm paralysis that is most often asymptomatic. However, it may result in more serious complications for high-risk individuals including elevated BMI, current vape or tobacco use, or concurrent respiratory pathology including OSA, asthma, COPD, ILD, etc. Workup of respiratory failure after first rib resection includes imaging studies such as chest x-ray, computed tomography, and fluoroscopy, all of which expose patients to radiation and can be time consuming (2)."

Case report • Clinical • Anesthesia • Asthma • Cardiovascular • Chronic Obstructive Pulmonary Disease • Hypertension • Immunology • Infectious Disease • Musculoskeletal Diseases • Obstructive Sleep Apnea • Orthopedics • Pneumonia • Pulmonary Embolism • Respiratory Diseases • Sleep Disorder • Vascular Neurology

ECMO Cannulation after Pulmonary Endarterectomy for Management of Chronic Thromboembolic Pulmonary Hypertension: A Bridge to Recovery and Transplant (IARS-SOCCA 2025) - "Transitioning from the operating room to ICU, hemodynamics were supported with Dobutamine (2.5 mcg/kg/min), Epinephrine (0.08 mcg/kg/min), Norepinephrine (0.08 mcg/kg/min), Vasopressin 0.04 U/min), Milrinone (0.25 mcg/kg/min), and inhaled Epoprostenol and Nitric Oxide. CTEPH is a rare and challenging condition to manage with definitive treatment being pulmonary thromboendarterectomy. Recovery after PEA is a critical period when pulmonary hypertension may be exacerbated by pre-capillary post-operative inflammation and remodeling, eventually causing rising PAP, hypoxemia and decompensated right heart failure. Lung or heart-lung transplantation is considered in patients with significant PAH despite PEA."

Cardiovascular • Congestive Heart Failure • Heart Failure • Hepatology • Infectious Disease • Inflammation • Liver Failure • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Transplantation

A Case of Saddle Pulmonary Embolism Following V-A ECMO Decannulation (IARS-SOCCA 2025) - "She remains normotensive, but an epinephrine drip and inhaled epoprostenol are started for right heart support. ECMO is a life-sustaining therapy that provides essential support for the pulmonary and/or cardiovascular system during critical illness. Despite routine use of therapeutic anticoagulation, thrombotic complications from ECMO are frequently noted and associated with higher levels of in-hospital mortality [2]. Routine screening and anticoagulation after ECMO decannulation are suggested in some studies [3]."

Clinical • Cardiovascular • Chronic Kidney Disease • Coronary Artery Disease • Dyslipidemia • Hematological Disorders • Hypertension • Myocardial Infarction • Nephrology • Pulmonary Disease • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Venous Thromboembolism

ACUTE CHEST SYNDROME AND SEVERE BIVENTRICULAR FAILURE: ROLE OF VA ECMO (SCCM 2025) - "He was started on bumetanide drip, norepinephrine, vasopressin, dobutamine infusion, and inhaled epoprostenol. Currently, this decision is left to physician's discretion. Therefore, guidelines for initiation of VA-ECMO in ACS and BV failure are direly needed."

Cardiovascular • Genetic Disorders • Hematological Disorders • Musculoskeletal Pain • Pain • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Sickle Cell Disease

INHALED EPOPROSTENOL FOR PATIENTS WITH ACUTE RESPIRATORY FAILURE (SCCM 2025) - "Patients who received inhaled epoprostenol after cardiac surgery, received inhaled nitrous oxide, or received intravenous epoprostenol were excluded. The use of inhaled epoprostenol in patients with acute hypoxemic respiratory failure improved oxygenation in selected patients with no differences in duration of mechanical ventilation, length of stay, or mortality."

Clinical • Cardiovascular • Infectious Disease • Pneumonia • Respiratory Diseases

COMMUNITY-ACQUIRED ACINETOBACTER BAUMANNII PNEUMONIA: AN UNUSUAL BUT DEADLY PATHOGEN (SCCM 2025) - "He was started on vancomycin and cefepime and given a fluid bolus...Infectious disease recommended cefiderocol, metronidazole and a single dose of gentamicin...Continuous inhaled epoprostenol was given...Though often not as drug resistant as the nosocomial Acinetobacter, community-acquired infections are associated with higher mortality and more severe presentations. This rare and ultimately fatal case highlights the severity of Acinetobacter baumannii as a community-acquired pathogen."

Addiction (Opioid and Alcohol) • Cardiovascular • Chronic Obstructive Pulmonary Disease • Diabetes • Immunology • Infectious Disease • Metabolic Disorders • Pneumonia • Respiratory Diseases • Septic Shock

VEXUS-GUIDED HEMODYNAMIC MANAGEMENT OF POSTOPERATIVE PERICARDIECTOMY ACUTE KIDNEY INJURY (SCCM 2025) - "Post-intubation, he had mixed vasoplegic and cardiogenic shock with low CI and CVP 16-18, and oliguric acute kidney injury (AKI) despite furosemide infusion and inhaled epoprostenol...VExUS on POD 5 confirmed ongoing congestion and dobutamine was added for additional forward flow support and diastolic relaxation, with improvement in UO...Traditional measurements of volume status such as CVP may not be reliable in the setting of rapidly changing vasomotor tone, negative vs positive pressure ventilation, and type of inotropic support. VExUS can provide information about the impact of filling pressures on end-organ congestion in the setting of difficult to interpret traditional echocardiographic findings."

Acute Kidney Injury • Cardiovascular • Infectious Disease • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases

NAVIGATING A STORM: REFRACTORY VT IN A VAD PATIENT WITH AMIODARONE TOXICITY AND AORTIC INSUFFICIENCY (SCCM 2025) - "The patient was placed on Milrinone and inhaled epoprostenol for RV support. This can further result in inadequate LV offloading, elevated wedge pressure, pulmonary hypertension, and RV dysfunction. This case emphasizes the importance of vigilant monitoring and early intervention in managing complications of LVAD therapy."

Clinical • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Endocrine Disorders • Heart Failure • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Ventricular Tachycardia

COMPARISON OF INHALED EPOPROSTENOL AND NITRIC OXIDE FOR COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME (SCCM 2025) - "Compared to iEPO, use of iNO in COVID-19 patients with moderate to severe ARDS significantly improved PaO2:FiO2 ratio and reduced mortality in a group of patients with high overall risk of death. The increased length of hospital stay in the iNO group may represent survival bias."

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

Inhaled Epoprostenol in Children With Pediatric Acute Respiratory Distress Syndrome: A Single-Center Retrospective Study. (PubMed, Pediatr Pulmonol) - "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."

Journal • Retrospective data • Acute Respiratory Distress Syndrome • Cardiovascular • Critical care • Hypertension • Pediatrics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Evaluating Clinical Outcomes of Inhaled Epoprostenol Usage for Hypoxic Respiratory Failure in Critically Ill Mechanically Ventilated Adults at a Community based Hospital (ASHP 2024) - No abstract available

Clinical • Clinical data • Respiratory Diseases

Inhaled epoprostenol via high-flow nasal cannula and intravenous treprostinil for management of severe pulmonary arterial hypertension during cesarean delivery with epidural anesthesia: a case report. (PubMed, Int J Obstet Anesth) - "This report highlights the novel use of iEpo via HFNC for managing PAH during cesarean delivery, suggesting its potential for reducing maternal morbidity and mortality in this high-risk population. Future studies should explore the simultaneous use of inhaled and intravenous prostacyclin analogs in pregnant patients with PAH."

Journal • Anesthesia • Cardiovascular • Heart Failure • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases