title: Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation. Munich Lung Transplant Group.
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 transplantation.
  
  
  METHODS
  Prospective clinical dose-response study.
  
  
  METHODS
  Anesthesiological intensive care unit of a university hospital.
  
  
  METHODS
  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).
  
  
  METHODS
  Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Germany.
authors.forename: G I
authors.initials: GI
authors.lastname: Kemming
authors.forename: M J
authors.initials: MJ
authors.lastname: Merkel
authors.forename: A
authors.initials: A
authors.lastname: Schallerer
authors.forename: O P
authors.initials: OP
authors.lastname: Habler
authors.forename: M S
authors.initials: MS
authors.lastname: Kleen
authors.forename: M
authors.initials: M
authors.lastname: Haller
authors.forename: J
authors.initials: J
authors.lastname: Briegel
authors.forename: C
authors.initials: C
authors.lastname: Vogelmeier
authors.forename: H
authors.initials: H
authors.lastname: Fürst
authors.forename: B
authors.initials: B
authors.lastname: Reichart
authors.forename: B
authors.initials: B
authors.lastname: Zwissler
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide