VentaProst (epoprostenol inhalation) / Aerogen Pharma - LARVOL DELTA

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

IMPACT OF INHALED EPOPROSTENOL ON ICU LENGTH OF STAY AND MORTALITY WHEN USED FOR PULMONARY HYPERTENSION IN A SINGLE ACADEMIC MEDICAL CCU AND ICU (CHEST 2025) - "Our results show that patients with PH and similarly high APACHE-II scores treated with iEPO in our medical and cardiac ICUs had high 30-day mortality and prolonged lengths of stay in the ICU. Non-survivors remained on iEPO treatment longer than survivors. CLINICAL IMPLICATIONS: Our study shows that despite the potential for hemodynamic improvement seen in patients with PH treated with iEPO, iEPO may not be beneficial in PH patients treated in a CCU/ICU setting."

Cardiovascular • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

THE UNCLASSIFIED PHENOTYPE: SEVERE PULMONARY HYPERTENSION WITH LOW DLCO AND CAPILLARY REMODELING CHALLENGING DIAGNOSTIC BOUNDARIES: A CASE REPORT (CHEST 2025) - "He was initiated on IV steroids, DuoNeb, and budesonide nebulizations, along with IV diureses...The patient was aggressively diuresed and was initiated on inhaled Flolan therapy. Given the severity of his PH with reduced CI and severely elevated PVR, the patient was then transferred to a tertiary care center for IV Epoprostenol therapy and evaluation for a lung transplant... This case report highlights the diagnostic challenges and the importance of considering capillary remodeling in patients with rapidly progressing severe PH with low DLCO and smoking history and a need for early referral to lung transplant. Advanced imaging, genetic studies, and more detailed clinical profiles can aid in refining diagnostic criteria and potentially lead to new subcategories in PH classification that are more inclusive of these phenotypes."

Case report • Clinical • Cardiovascular • Congestive Heart Failure • Dyslipidemia • Heart Failure • Immunology • Nicotine Addiction • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Tobacco Addiction

WHEN CATECHOLAMINES SPARK PROPOFOL INFUSION SYNDROME: A CASE AT LOW DOSE (CHEST 2025) - "On arrival to UMC, he was on four pressors (dobutamine, norepinephrine, epinephrine, vasopressin)...Transthoracic echocardiogram showed moderately dilated right ventricle with moderate to severely reduced systolic function and right ventricular systolic pressure of 40-50 mmHg consistent with pulmonary hypertension, patient was started on continuous inhaled epoprostenol... Clinicians should remain vigilant for the risk of PRIS, particularly in patients receiving high doses of catecholamines, even when propofol is administered at lower doses or for shorter durations. Early recognition and intervention are critical to improving outcomes."

Clinical • Acute Kidney Injury • Anesthesia • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Diabetes • Endocrine Disorders • Heart Failure • Hematological Malignancies • Hypertension • Metabolic Disorders • Myelodysplastic Syndrome • Nephrology • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases • Type 2 Diabetes Mellitus

COMPARATIVE EFFICACY AND SAFETY OUTCOMES OF INHALED EPOPROSTENOL AND INHALED NITRIC OXIDE IN MANAGING REFRACTORY HYPOXEMIA IN ARDS: A SYSTEMATIC REVIEW AND META-ANALYSIS (CHEST 2025) - "This meta-analysis suggests that iEPO is associated with an increase in Ventilator-Free Days but does not show significant differences in other efficacy or safety outcomes compared to iNO. However, the study has limitations, including the retrospective nature of the included studies, which are subject to inherent biases and high heterogeneity. Further well-designed RCTs are essential to provide more definitive evidence regarding the comparative effectiveness and safety of these therapies in managing ARDS."

Retrospective data • Review • Acute Respiratory Distress Syndrome • Hematological Disorders • Hypotension • Inflammation • Nephrology • Renal Disease • Respiratory Diseases • Thrombocytopenia

Management of intraoperative ischemic right ventricular failure not amenable to surgical revascularization during repair of type A aortic dissection (ASA 2025) - "His intraoperative course was complicated by failure of his existing right coronary artery (RCA) saphenous vein graft with no new RCA target available for bypass, resulting in ischemic right ventricular failure. This case report will discuss the subsequent maximal medical management of ischemic right ventricular failure, including veno-arterial extracorporeal membrane oxygenation, intra-aortic balloon pump insertion, vasopressor and inotrope infusions, inhaled epoprostenol, endotracheal milrinone, and additional methods which were not utilized including mechanical RV support devices."

Anesthesia

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