Inhaled vasodilators nitric oxide and epoprostenol have similar outcomes in respiratory failure

Adult patients who were being mechanically ventilated and started on inhaled nitric oxide, epoprostenol, or both were discovered using a sizable United States database (Premier Healthcare Database). The efficacy of inhaled nitric oxide was compared to epoprostenol by restricting analysis to patients admitted to hospitals that exclusively employed either inhaled nitric oxide or epoprostenol, taking advantage of the considerable hospital diversity in the choice of first inhaled vasodilator. 

The key findings of this study were as follows:

1. Among 11,200 patients (303 institutions), 6,366 (56.8%) had nitric oxide breathed first, 4,720 (42.1%) had epoprostenol inhaled first, and 114 (1.0%) had both therapies on the same day.

2. 104 hospitals (34.3%; 1,666 patients) utilized nitric oxide solely, whereas 118 hospitals (38.9%; 1,812 patients) used epoprostenol entirely.

3. There were no differences in the risk of successful extubation between patients treated at nitric oxide-only hospitals and those admitted to epoprostenol-only hospitals (sub-distribution hazard ratio 0.97, 95% confidence interval 0.80-1.18).

4. There were no changes in overall hospital expenses or mortality rates.

5. Multiple sensitivity studies yielded consistent results.

Reference:

Bosch, N. A., Law, A. C., Vail, E. A., Gillmeyer, K. R., Gershengorn, H. B., Wunsch, H., & Walkey, A. J. (2022). Inhaled nitric oxide versus epoprostenol during acute respiratory failure: an observational target trial emulation. In Chest. Elsevier BV. https://doi.org/10.1016/j.chest.2022.08.001