Inhaled Epoprostenol (Flolan) - Respiratory

Question 1

What are the 3 indications for inhaled Flolan as per the MDSO?

Answer 1

1. Severe ARDS with refractory hypoxemia
2. Pulmonary hypertension
3. Right sided heart failure

Question 2

What are the 2 contraindications and 4 relative contraindications to inhaled Flolan as per the MDSO?

Answer 2

1. Severe left ventricular systolic dysfunction
2. Pulmonary hemorrhage
3. Thrombocytopenia (platelets <50 x 109/L)
4. Active hemorrhage
5. Pulmonary edema
6. Hypotension

Question 3

Is inhaled Flolan a mandatory patch and should it be titrated while in transport?

Answer 3

Yes, it’s a mandatory patch and hells no it shouldn’t be titrated during transport

Question 4

What 3 improvements with inhaled Flolan are considered a favourable response?

Answer 4

1. > 20% improvement in PaO2 or P/F ratio OR
2. > 15% reduction in mean pulmonary artery pressure OR
3. > 15% increase in cardiac output

Question 5

What 3 setbacks with inhaled Flolan are considered an unfavourable response?

Answer 5

1. <20% improvement in PaO2 or P/F ratio OR
2. <15% reduction in mean pulmonary artery pressure OR
3. <15% increase in cardiac output

Question 6

What happens when inhaled Flolan is suddenly discontinued, and when does the effect usually present itself?

Answer 6

Rebound pulmonary vasoconstriction, usually within 30 minutes of discontinuation.

If epiprostonol is weaned or discontinued prior to crew arrival ensure that pt remains stable for at least 30 minutes prior to transport

Question 7

If a patient is on inhaled Flolan how often should the filters be changed to ensure consistent drug delivery and to avoid auto-PEEPing from sticky/blocked filters?

Answer 7

Change filters q2 hours

Question 8

What is the procedure for transporting a patient on inhaled Flolan, and how should the breathing circuit be configured?

Answer 8

1. Determine dose, when the last titration occurred, if there were any ventilatory or hemodynamic changes and latest ABGs
2. Patch to TMP to obtain orders to continue Flolan
3. Ensure adequate amount of Flolan is obtained for transport and shielded from light

Place 1 HME at T1 inspiratory port, connect Aerogen nebulizer between the inspiratory limb HME and the inspiratory limb circuit. Attach 2 filters in sequence to the expiratory valve at the distal end of the breathing circuit.