Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin

Objective: To evaluate hemodynamic and oxygenation changes of combined ther apy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IA P) during lung transplantation. Design: Prospective study. Setting: University hospital. Participants: Ten patients scheduled for lung transplantation. Interventions: Ten patients, with a mean age of 38 years (range, 24 to 56 y ears), were scheduled for lung transplantation (2 single-lung transplantati ons and 8 double-lung transplantations). During first lung implantation wit h single-lung perfusion and ventilation, hemodynamic and oxygenation data w ere analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery cl amping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (2 0 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combi ned administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% ox ygen. Measurements and Main Results: During the inhaled NO phase, reductions of m ean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0. 05) were noted. After the start of prostacyclin inhatation, a further decre ase in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/F1O2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonar y shunt decreased (p < 0.05). Conclusion: This study confirms the action of inhaled NO as a selective pul monary vasodilator during lung transplantion. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygen ation compared with inhaled NO administered alone without any systemic chan ges. Copyright (C) 2001 by W.B. Saunders Company.