Nebulizer Treatment in Cardiac Patients

The use of nebulizer treatments in some cardiac (heart) patients helps improve outcomes and survival. A nebulizer machine changes liquid medication into fine droplets (aerosol or mist form) that are inhaled into the lungs. Medication is delivered with a mask or respiratory ventilator, then absorbed through the arteries in the lungs to be delivered to the body. Studies detail several helpful medications for cardiac problems.

Iloprost

• Iloprost is a medication used to treat symptoms of pulmonary hypertension (a type of high blood pressure affecting only the arteries in the lungs and the right side of the heart). It works by blocking a hormone found in these patients, increasing blood supply to the heart, and decreasing the workload of the heart. According to the Journal of Clinical Anesthesia, iloprost represents a useful drug for cardiac transplantation patients. The Society of Thoracic Surgeons also reported a similar study.

Prostacyclin

• Cardiothoracic surgery includes bypass grafting and valve replacement

  Prostacyclin is another aerosol medication used for treatment of pulmonary hypertension. It opens up the arteries in the lungs and heart (vasodilator) without affecting the patient's blood pressure. The Jounal of Thoracic and Cardiovascular Surgery reports "inhaled prostacyclin is safe, effective and affordable in patients with pulmonary hypertension after cardiothoracic surgery." Using prostacyclin in the nebulized form appears to be more effective at reducing pulmonary artery pressure when compared to using it intravenously, according to the European Heart Journal.

Milrinone

• Milrinone, also a potent dilator of arteries, adjusts calcium levels in cells. A study done by The International Anesthesia Research Society found that inhaled milrinone alone, or in combination with prostacyclin may present a therapeutic option for patients with pumonary hypertension and heart failure following cardiac surgery or heart transplantation. As an alternative medication, inhaled milrinone may be a better choice, as it does not require a complex setup, is less expensive, and no toxic by-products are produced.

Nitric Oxide

• Nitric oxide is a potent vasodilator when used as an inhalant to treat pulmonary hypertension. Unfortunately, this medication has its disadvantages. Nitric oxide requires special monitoring when given, as it is a toxic molecule and can produce harmful by-products in the body. Because of its short half-life, nitric oxide must be administered continuously, and even brief interruptions can cause a dangerous rebound of pulmonary hypertension.

Considerations

• Administering drugs by inhalation is advantageous because large concentrations are absorbed by the lung circulation. However, considerations should be made when choosing a certain medication. Nitric oxide, as stated above, can be potentially toxic, and requires specialized delivery systems and monitoring. In contrast, prostacyclin exerts no toxic effects, and studies have reported selective vasodilation right in the lungs where it's needed. Prostacyclin, milrinone, and Iloprost are also less expensive than the nitric oxide, while shown to be just as effective.