epoprostenol (Caripul)

Haemodynamic remission and transition off epoprostenol after upfront triple therapy in PAH.

Ogo Takeshi T, Hayashi Hiroya H, Takano Ryo R, Fujisaki Shinya S et al.

A Case Series of Raynaud's Phenomenon in the Setting of Immune Checkpoint Inhibitors.

Li Yuanteng Jeff YJ, Buni Maryam M, Tayar Jean H JH, Lu Huifang H et al.

Although immune checkpoint inhibitors (ICIs) have improved oncological outcomes, they can cause a myriad of inflammatory conditions known as immune-related adverse events (irAEs). Raynaud's phenomenon (RP) is a rare rheumatologic irAE that may arise de novo or present as an exacerbation of preexisting disease. This case series aims to describe ICI-induced RP in patients without a rheumatological diagnosis seen at a large, specialized cancer center. Our case series describes five patients with ICI-induced RP who were evaluated by rheumatology at a cancer center during the past 3 years where their cancers, type of ICIs, diagnostic tests, and treatments are discussed in detail. Among our five patients, one patient had preexisting psoriatic arthritis, and one had preexisting RP. The outcome of our patients' ICI-induced RP varied widely. Although three patients had significant digital ischemia resulting in ulceration requiring epoprostenol infusions, the remaining two patients had mild digital ischemia that were controlled conservatively. However, none of our patients had clinical features to suggest systemic sclerosis (SSc), where RP is often the first symptom. Interestingly, interferon-γ and interleukin-6 were the most frequently elevated cytokines when checked in these patients. This is the first case series, to the authors' knowledge, to describe ICI-induced RP, which may occur without other clinical features of an autoimmune rheumatological disease. The severity of the disease may vary, but it warrants increased awareness and prompt initiation of appropriate treatment.

Intraoperative Continuous Kidney Replacement Therapy With Regional Epoprostenol Anticoagulation During Liver Transplantation in a Child With Severe Gastrointestinal Bleeding.

Eyduran Eda E, İyi Duygu D, Aslan Ayşen Durak AD, Huseyinova Ulkar U et al.

Acute kidney injury (AKI) is a significant complication in pediatric liver transplant (LT) patients. This is often exacerbated by liver dysfunction, fluid overload, and metabolic disturbances. Intraoperative continuous kidney replacement therapy (IO-CKRT) is an emerging strategy to manage these complex patients, aiming to stabilize fluid, electrolyte, and acid-base imbalances. Epoprostenol is utilized as an anticoagulant during CKRT to maintain circuit patency, particularly in patients at high risk of bleeding by inhibiting platelet aggregation. However, the use of IO-CKRT with epoprostenol specifically in pediatric LT recipients is poorly documented. We present a case of a 12 year-old girl with biliary atresia and cirrhosis who underwent urgent LT from a deceased donor. She developed hemorrhagic shock and multi-organ failure, necessitating pre-transplant plasmapheresis and subsequent CKRT with epoprostenol. IO-CKRT was maintained during the 12 h LT to manage acid-base balance, electrolyte levels, and volume status. Despite epoprostenol anticoagulation for hemofiltration, no abnormal bleeding occurred in the gastrointestinal or surgical areas during transplantation. Post-transplantation, the patient's inotropic support requirements decreased within 24 h. IO-CKRT effectively achieves fluid and metabolic balance during LT in pediatric patients with AKI, fluid overload, and metabolic issues. Epoprostenol proves to be a safe and effective regional anticoagulation option for CKRT in bleeding patients undergoing LT, preventing site bleeding without systemic complications. This case highlights a unique and important application that warrants further investigation into its broader effectiveness and potential complications in this vulnerable patient population.

The association between documented right ventricular dysfunction and in-hospital mortality in mechanically ventilated critically ill patients receiving a noradrenaline infusion: A retrospective observational cohort study.

Tan Li H LH, Paul Eldho E, Simpson Alex A, Marasco Silvana S et al.

To determine the documentation of right ventricular dysfunction (RVD) in mechanically ventilated patients receiving a noradrenaline infusion, and to assess the association with in-hospital mortality, length of stay (LOS) and treatment intensity. This single-centre, retrospective, observational cohort study included patients admitted to the intensive care unit (ICU) between January 2020 and December 2023, with elevated serum lactate levels, who received invasive mechanical ventilation and an intravenous noradrenaline infusion, within the first 7 days. Exposure was defined on the basis of documentation of RVD in the medical record; e.g. those with RVD vs those without RVD. The primary outcome was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital LOS, organ support modalities, and the utilisation of echocardiography. Comparison between groups utilised logistic and linear regression models. Of 1234 patients included in the study, 273 had documented RVD (22.1%). There was no difference in crude in-hospital mortality (RVD, 24.9% vs no RVD, 23.6% p = 0.66) between groups. Risk-adjusted in-hospital (odds ratio [OR]: 1.65: 1.13-2.41, p = 0.01) and ICU mortality (OR: 1.88: 1.26-2.81, p = 0.002) were greater in those with documented RVD. Median ICU (13.4 vs 10.2 days, p = 0.001) and hospital (25.1 vs 22.5 days, p = 0.002) LOS were significantly longer in the RVD group. A greater number of interventions were provided in those with RVD, including: inhaled nitric oxide (39.6% vs 7.8%, p < 0.001), epoprostenol (1.8% vs 0.1%, p < 0.001), milrinone infusion (77.3% vs 23.6%, p < 0.001), continuous renal replacement therapy (48.7% vs 25.8%, p < 0.001), and extracorporeal membrane oxygenation (33.7% vs 10.4%, p < 0.001). The median number of transthoracic (TTE) or transoesophageal echocardiography (TOE) was 3 (interquartile range [IQR]: 1-4) in those with RVD, compared to 1 (IQR: 1-2) in those without RVD (p < 0.001). Approximately 1 in 4 patients who were mechanically ventilated and receiving noradrenaline had documented RVD, which was associated with a higher risk-adjusted in-hospital mortality, longer LOS, and greater treatment intensity.