Inhaled nitric oxide does not prevent pulmonary edema after lung transplantation measured by lung water content: a randomized clinical study.
OBJECTIVE
In order to assess the effects of inhaled nitric oxide (iNO) in preventing early-onset lung edema from occurring after lung transplantation, we measured extravascular lung water (EVLW) in a group of lung transplant recipients who were at high risk for developing ischemia-reperfusion-induced lung injury.


METHODS
Prospective, randomized study.


METHODS
Surgical ICU in a teaching hospital.


METHODS
Thirty double-lung transplant recipients.


METHODS
Patients were randomized to receive or not receive 20 ppm iNO at the time of reperfusion (ie, before any occurrence of lung edema). In the NO group, iNO was then administered for a 12-h period. A double-dilution technique was used for the serial assessment of EVLW, intrathoracic blood volume, and cardiac index. Standard hemodynamic and pulmonary parameters were also recorded during the first 3 postoperative days.


RESULTS
Patients who received iNO did not have a different lung water content compared to control subjects (p = 0.61 [by analysis of variance (ANOVA)]). Blood oxygenation (ie, Pao(2)/fraction of inspired oxygen [Fio(2)] ratio) did not differ between the two groups (p = 0.61 [by ANOVA]). In both groups, EVLW and Pao(2)/Fio(2) ratio dropped significantly over time, regardless of the use of iNO (p < 0.01 [by ANOVA]).


CONCLUSIONS
In the population studied, prophylactic iNO that was administered at 20 ppm had no effect on pulmonary edema formation and resolution following lung transplantation.
Perrin
Gilles
G
Département d'Anesthésie Réanimation, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France. gilles.perrin@mail.ap-hm.fr
Roch
Antoine
A
Michelet
Pierre
P
Reynaud-Gaubert
Martine
M
Thomas
Pascal
P
Doddoli
Christophe
C
Auffray
Jean-Pierre
JP
D000280:Administration, Inhalation; D000328:Adult; D045462:Endothelium-Dependent Relaxing Factors / Q000008:administration & dosage*; D015633:Extravascular Lung Water / Q000187:drug effects; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology* / Q000517:prevention & control*; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D017211:Treatment Failure
D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide