2026 Southeastern Residency Conference

Evaluation of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome in ICU
Gun Moon, Christen Freeman, Alston Poellnitz
DCH Regional Medical Center, Tuscaloosa, AL

Learning Objective: Identify the oxygenation response and appropriate utilization of inhaled epoprostenol in ICU patients with acute respiratory distress syndrome.

Self-Assessment Question:
Abrupt discontinuation of inhaled epoprostenol may lead to rebound pulmonary hypertension and worsening hypoxemia. True or False?

Background: Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. Inhaled epoprostenol is used as salvage therapy. The study evaluated its impact on oxygenation, utilization, protocol adherence, and hospital outcomes.

Methods:
This IRB-exempt, single-center retrospective chart review study included adult ICU patients who received inhaled epoprostenol for ARDS at a 583-bed community hospital from January 2024 to August 2025. Patients required documented SpO₂ and FiO₂ values within 120 minutes before and 4 hours after initiation. The primary outcome was oxygenation response, defined as >15% improvement in SpO₂:FiO₂ at 4 hours. Secondary outcomes included appropriate use as salvage therapy, adherence to institutional titration/discontinuation protocol implemented in January 2025, ICU length of stay, ventilator-free days, and mortality.

Results:
Fifty patients were included with mean age of 60.4 years, with 70% of patients meeting severe ARDS criteria defined by PaO2:FiO2 <100. Seventeen patients (34%) met criteria for oxygenation response. Overall, 68% demonstrated increased SpO₂:FiO₂ from baseline, while 22% decreased and 10% showed no change. Appropriate use as salvage therapy was observed in 86% of patients. Appropriate titration/discontinuation occurred in 44.4% of patients prior to protocol implementation and 47.8% after implementation. Mean ICU length of stay was 9.1 ± 5.7 days, ventilator-free days were 20.7 ± 4.8 days, and mortality was 60%.

Conclusion:
Despite appropriate use as salvage therapy, inhaled epoprostenol demonstrated limited clinically meaningful improvement in oxygenation. Protocol adherence for titration and discontinuation remained inconsistent. Findings suggest the need for provider education, improved documentation, and evaluation of non-responders, including delays in discontinuations. Standardized discontinuation criteria may optimize use and reduce unnecessary resource utilization.

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