Intensive Care Medicine

, Volume 24, Issue 11, pp 1173–1180 | Cite as

Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation

  • G. I. Kemming
  • M. J. Merkel
  • A. Schallerer
  • O. P. Habler
  • M. S. Kleen
  • M. Haller
  • J. Briegel
  • C. Vogelmeier
  • H. Fürst
  • B. Reichart
  • B. Zwissler
  • Munich Lung Transplant Group
ORIGINAL

Abstract

Objective: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantion. Design: Prospective clinical dose- response study. Setting: Anesthesiological intensive care unit of a university hospital. Patients and participants: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FIO2) of less than 13.3 kPa (100 mmHg). Interventions: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. Measurements and results: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p < 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO2 increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO2), all were subject to long-term inhalation (1–19 days). All were successfully weaned from NO and were discharged from the intensive care unit. Conclusion: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation.

Key words Lung transplantation Inhaled vasodilators Nitric oxide Pulmonary hypertension Selective pulmonary vasodilation Reperfusion injury 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • G. I. Kemming
    • 1
  • M. J. Merkel
    • 1
  • A. Schallerer
    • 1
  • O. P. Habler
    • 1
  • M. S. Kleen
    • 1
  • M. Haller
    • 1
  • J. Briegel
    • 1
  • C. Vogelmeier
    • 2
  • H. Fürst
    • 3
  • B. Reichart
    • 4
  • B. Zwissler
    • 1
  • Munich Lung Transplant Group
  1. 1.Department of Anesthesiology, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Marchioninistrasse 15, D-81 377 München, Germany e-mail: bernhard.zwissler@ana.med.uni-muenchen.de Tel. + 49 (89) 7095-3417 Fax + 49 (89) 7095–8886DE
  2. 2.Department of Internal Medicine, Ludwig-Maximilians-Universität München, München, GermanyDE
  3. 3.Department of Surgery, Ludwig-Maximilians-Universität München, München, GermanyDE
  4. 4.Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, München, GermanyDE

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