Severe reperfusion lung injury after double lung transplantation.
OBJECTIVE
To demonstrate the effects of combined inhaled nitric oxide and surfactant replacement as treatment for acute respiratory distress syndrome. This treatment has not previously been documented for reperfusion injury after double lung transplantation.


METHODS
A 24-year-old female with cystic fibrosis underwent double lung transplantation. During implantation of the second lung a marked increase in pulmonary artery pressure associated with systemic hypotension, hypoxemia and low cardiac output were observed. Notwithstanding the patient received support from cardiovascular drugs and pulmonary vasodilators cardiopulmonary by-pass was necessary. In the intensive care unit the patient received the same drug support, inhaled nitric oxide and two bronchoscopic applications of bovine surfactant.


RESULTS
A rapid improvement in PaO2/FiO2 within 2-3 hours of administration of surfactant was seen. The patient is well at follow-up 1 year post-transplant.


CONCLUSIONS
There is a potential role for a combined therapy with inhaled nitric oxide and surfactant replacement in reperfusion injury after lung transplantation.
Istituto di Anestesiologia e Rianimazione, University of Rome La Sapienza, Rome, Italy. giorgio.dellarocca@uniroma1.it
Giorgio
G
Della Rocca
Federico
F
Pierconti
Maria Gabriella
MG
Costa
Cecilia
C
Coccia
Livia
L
Pompei
Monica
M
Rocco
Federico
F
Venuta
Paolo
P
Pietropaoli
D000280:Administration, Inhalation; D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D009569:Nitric Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology; D014665:Vasodilator Agents / Q000627:therapeutic use*
D011663:Pulmonary Surfactants; D014665:Vasodilator Agents; D009569:Nitric Oxide; D010100:Oxygen