Document Detail


Inhaled nitric oxide in the treatment of postoperative graft dysfunction after lung transplantation.
MedLine Citation:
PMID:  8179406     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pulmonary hypertension and transient graft dysfunction may complicate the postoperative course of patients undergoing lung transplantation. We report the acute effect of inhaled nitric oxide (80 ppm) on hemodynamics and gas exchange in 6 patients (median age, 14 years; range, 5 to 21 years) after lung transplantation as well as the effect of extended treatment over 40 to 69 hours in 2 patients. In 5 patients with pulmonary hypertension nitric oxide lowered mean pulmonary artery pressure (from 38.4 +/- 1.6 to 29.4 +/- 3.1 mm Hg; p < 0.05), pulmonary vascular resistance index (from 9.3 +/- 1.4 to 6.4 +/- 1.3 Um2; p < 0.05), and intrapulmonary shunt fraction (from 28.6% +/- 8.3% to 21.0% +/- 5.7%; p < 0.05). There was a 28.4% +/- 7.2% reduction in transpulmonary pressure gradient with only minor accompanying effects on the systemic circulation. Mean arterial pressure decreased only 2.7% +/- 5% (from 76.4 +/- 2.2 to 74 +/- 2.3 mm Hg; p = not significant), and systemic vascular resistance index by 4.2% +/- 9.7% (from 21.7 +/- 3.1 to 20.6 +/- 3.6 Um2; p = not significant). Cardiac index was unchanged (from 3.5 +/- 0.8 to 3.6 +/- 0.7 L.min-1.m-2; p = not significant). Nitric oxide caused a sustained improvement in oxygenation and pulmonary artery pressure during extended therapy at doses of 10 ppm. There were no major side effects. However, transient methemoglobinemia (9%) developed in 1 patient after 10 hours of nitric oxide treatment. Nitric oxide may be useful in the treatment of pulmonary hypertension and the impaired gas exchange that occurs after lung transplantation.
Authors:
I Adatia; C Lillehei; J H Arnold; J E Thompson; R Palazzo; J C Fackler; D L Wessel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  57     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-06-08     Completed Date:  1994-06-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1311-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / administration & dosage
Administration, Inhalation
Adolescent
Adult
Breath Tests
Child
Child, Preschool
Female
Hemodynamics / drug effects*
Humans
Hypertension, Pulmonary / drug therapy*,  etiology,  physiopathology
Infusions, Intra-Arterial
Lung Transplantation / adverse effects*
Male
Methemoglobin / analysis
Nitric Oxide / administration & dosage*
Nitrogen Dioxide / analysis
Pulmonary Circulation / drug effects
Pulmonary Gas Exchange / drug effects*
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide; 10102-44-0/Nitrogen Dioxide; 51-84-3/Acetylcholine; 9008-37-1/Methemoglobin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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