Effects of Inhaled Pulmonary Vasodilators on Perioperative Right Ventricular Hemodynamics: Are These “Nebs” Simply Nebulous?

2][3][4][5][6] Although several medical and device therapies exist to address the failing RV in these critically ill patients, 1-5 the safety and efficacy of inhaled pulmonary vasodilators on perioperative RV function and hemodynamics remains poorly understood.In the study by Elmi-Sarabi, Denault, and colleagues, published in this issue of the Canadian Journal of Cardiology, 7 the impact of inhaled dual pulmonary vasodilators in patients with or without RV dysfunction and PH undergoing cardiac surgery highlight several important areas for exploration (Figure 1): the safety and effectiveness of nebulized dual pulmonary vasodilators, inhaled epoprostenol (iE) and inhaled milrinone (iM); their impact on RV systolic and diastolic function and afterload and ventriculoarterial coupling; the optimal mode, timing, dose, and duration of drug administration; and the ability to predict therapeutic responsiveness and influence clinical outcomes.