A randomized trial of inhaled nitric oxide to prevent ischemia-reperfusion injury after lung transplantation.
Inhalation of nitric oxide (NO) has been advocated as a method to prevent ischemia-reperfusion injury after lung transplantation. We enrolled 84 patients into a concealed, randomized, placebo-controlled trial to evaluate the effect of inhaled NO (20 ppm NO or nitrogen) initiated 10 minutes after reperfusion on outcomes after lung transplantation. The groups (n = 42) were balanced with respect to age, sex, lung disease, procedure, and total ischemic times. PaO2/FIO2 ratios were similar on admission to the intensive care unit (ICU) (NO 361 +/- 134; control patients 357 +/- 132), and over the duration of the study. There were no differences in hemodynamics between the two groups. Severe reperfusion injury (PaO2/FIO2 < 150) was present at the time of admission to the ICU in 14.6% NO patients versus 9.5% of control patients (p = 0.48). The groups had similar median times to first successful trial of unassisted breathing (25 vs. 27 hours; p = 0.76), successful extubation (32 vs. 34 hours; p = 0.65), ICU discharge (3.0 days for both groups), and hospital discharge (27 vs. 29 days; p = 0.563). Five NO versus six control patients died during their hospital stay. Adjusting for age, sex, lung disease etiology, presence of pulmonary hypertension, and total ischemic time did not alter these results. In conclusion, we did not detect a significant effect of inhaled NO administered 10 minutes after reperfusion on physiologic variables or outcomes in lung transplant patients.
Meade
Maureen O
MO
FRCPC, Toronto General Hospital, 200 Elizabeth Street, EN 10-220, Toronto, ON, M5G 2C4 Canada.
Granton
John T
JT
Matte-Martyn
Andrea
A
McRae
Karen
K
Weaver
Bruce
B
Cripps
Paula
P
Keshavjee
Shaf H
SH
D000280:Administration, Inhalation; D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016040:Lung Transplantation; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D015424:Reperfusion; D015427:Reperfusion Injury / Q000517:prevention & control*; D012121:Respiration, Artificial; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D014665:Vasodilator Agents; D009569:Nitric Oxide