Flolan (epoprostenol) is an AWESOME medication. I remember the cardiovascular anesthesiologists using it all the time when I was a med student but never understood its true utility until this month working on the pulmonary critical care service.
Flolan is a potent vasodilator and is frequently used to control intraoperative pulmonary hypertension by dilating the pulmonary vasculature (blood vessels going to and from the lungs). In the setting of acute respiratory distress syndrome (ARDS) where patients have a whole lotta gunk (yes, that’s technical) in their alveoli, INHALED Flolan is incredibly useful. The vapors make their way down into alveoli which are still functional and dilate the pulmonary vessels associated with that alveolar sac. This tremendously improves “V/Q mismatch” – the cornerstone of pulmonary medicine – by improving blood flow (the ‘Q’) to the alveoli which are still receiving adequate ventilation (the ‘V’). This optimizes gas exchange significantly without compromising pulmonary mechanics.
Take home point: Flolan. It’s awesome. Use it.