Title: Standardizing Local Inhaled Epoprostenol Use in Acute Respiratory Distress Syndrome: A Quality Improvement Project
Authors: Adelaine Hogan, Ryan Lally, Rachel Langenderfer, Brittany NeSmith
Background: Inhaled epoprostenol (iEPO), a prostacyclin analogue-type pulmonary vasodilator, is often used off-label to treat hypoxemia in patients with acute respiratory distress syndrome (ARDS). Without guideline direction for use, preferences for iEPO dosing, timing of administration, and duration of therapy can vary. A medication use evaluation (MUE) of iEPO utilization for treatment of ARDS was conducted at Bon Secours St. Francis Downtown Hospital from January 1, 2023, through June 1, 2025, which found variation in initial doses and inappropriate prolonged duration of therapy. The purpose of this quality improvement project is to establish safe and efficient iEPO utilization practices when treating patients with ARDS through trial of a respiratory therapy-driven iEPO dosing and weaning protocol.
Methods/Results: This was a single-center, quality improvement project conducted at a 245-bed hospital in Greenville, South Carolina. An iEPO dosing and weaning protocol was developed by the investigators for use within the intensive care unit (ICU) to guide lab obtainment, initiation dose, and weaning parameters for all iEPO patients. The protocol was informed by current literature and reviewed and approved by a pharmacy-led interdisciplinary team of ICU pulmonologists and respiratory therapists. Educational material regarding ARDS, disease management, and protocol implementation was developed by investigators and distributed to ICU staff.
