CHEST Guidelines-Use-of-Parenteral-Prostanoids

Use-of-Parenteral-Prostanoids_chest

Pdf Summary

The document provides a comprehensive overview of the use of parenteral prostanoids in treating pulmonary arterial hypertension (PAH), highlighting key insights for chest physicians. Initially, PAH was a fatal disease with no effective treatment until the 1980s when continuous infusion of epoprostenol showed significant health improvements in patients. Over the past two decades, treatment options have expanded, including oral, inhaled, and subcutaneous medications supported by rigorous clinical trials. Despite guidelines recommending parenteral prostanoid therapy for high-risk PAH patients, studies like those by Hay and Tonelli revealed that numerous PAH-related deaths occurred without this treatment. Some patients refused such therapies due to the burdens and risks involved, while others were not suitable candidates due to severe comorbidities like metastatic cancer or end-stage renal disease.<br /><br />Clinicians must evaluate and document reasons for not initiating parenteral prostanoid therapy, especially for patients at high risk of death, considering predictors such as functional class, walking distance, and echocardiographic findings. Multi-disciplinary PAH centers should ensure that appropriate patients receive these therapies or have a well-documented rationale for withholding them. There is also a need for research into variations in clinical practice and the reasons for patients' refusal of treatment. This would help to refine treatment guidelines and improve patient safety outcomes in PAH management. Collaboration between comprehensive care centers is essential, and further investigation into unexpected deaths could prevent untimely deaths related to PAH. The document emphasizes the importance of referring PAH patients to expert centers for optimal treatment and assessment.

Keywords

parenteral prostanoids

pulmonary arterial hypertension

PAH treatment

epoprostenol

clinical trials

high-risk patients

treatment guidelines

multi-disciplinary centers

patient refusal

comprehensive care