Cardiothoracic & vascular anesthesia
The perioperative use of inhaled prostacyclins in cardiac surgery: a systematic review and meta-analysis
Authors' conclusion
The results of this systematic review and meta-analysis show that iPGI2s improved pulmonary hemodynamics with similar efficacy as other inhaled vasodilators, but caused a significant small decrease in arterial pressure when compared with placebo, indicating spill-over into the systemic circulation. These effects did not affect clinical outcomes.
Study context
- Population
- Adult and pediatric patients undergoing cardiac surgery with an increased risk of perioperative right ventricle failure
- Participants
- 734 participants · 13 RCTs
- Comparison
- Inhaled prostacyclins vs placebo or other inhaled or intravenous vasodilators
- Outcome
- Mean pulmonary artery pressure (MPAP)
Methodological detailsrandom-effect meta-analyses
- Random-effect meta-analyses
Pooled result
As reported in the abstract
Standardized effect size
0.46
95% CI 0.11–0.87P = 0.01
iPGI2s vs Placebo
Standardized effect size
1.26
95% CI 0.03–2.49P = 0.045
iPGI2s vs Intravenous vasodilators
Further pooled results
| Outcome | Standardized effect size (95% CI) | P value |
|---|---|---|
| Cardiac indexiPGI2s vs Intravenous vasodilators · significantly improved | 1.53 (0.50–2.57) | P = 0.004 |
| MAPiPGI2s vs Placebo · significantly lower with iPGI2s | −0.39 (−0.62 to 0.16) | P = 0.001 |
| MAPiPGI2s vs Intravenous vasodilators · higher with iPGI2s | 0.81 (0.29–1.33) | P = 0.002 |
Hemodynamics vs other inhaled vasodilators
- iPGI2s had similar effects as other inhaled vasodilators
Mortality
- Mortality not affected by iPGI2s
Original publication
The perioperative use of inhaled prostacyclins in cardiac surgery: a systematic review and meta-analysis. Can J Anaesth. Published 28 June 2023. doi:10.
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