Comparison of inhaled iloprost and nitric oxide in patients with pulmonary hypertension during weaning from cardiopulmonary bypass in cardiac surgery: a prospective randomized trial.
OBJECTIVE
The objective of this study was to compare the efficacy of inhaled iloprost and nitric oxide (iNO) in reducing pulmonary hypertension (PHT) during cardiac surgery immediately after weaning from cardiopulmonary bypass (CPB).


METHODS
A prospective randomized study.


METHODS
A single-center university hospital.


METHODS
Forty-six patients with PHT (mean pulmonary artery pressure (mPAP) > or = 26 mmHg preoperatively at rest, after anesthesia induction, and at the end of CPB) scheduled to undergo cardiac surgery were enrolled.


METHODS
Patients were randomly allocated to receive iloprost (group A, n = 23) or iNO (group B, n = 23) during weaning from CPB.


RESULTS
Heart rate, mean arterial pressure, central venous pressure, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, and left atrial pressure were recorded continuously. Iloprost and iNO were administered immediately after the end of CPB before heparin reversal. Both substances caused significant reductions in mean PAP (mPAP) and pulmonary vascular resistance (PVR) and significant increases in cardiac output 30 minutes after administration (p < 0.0001). However, in a direct comparison, iloprost caused significantly greater reductions in PVR (p = 0.013) and mPAP (p = 0.0006) and a significantly greater increase in cardiac output (p = 0.002) compared with iNO.


CONCLUSIONS
PHT after weaning from CPB was significantly reduced by the selective pulmonary vasodilators iNO and iloprost. However, in a direct comparison of the 2 substances, iloprost was found to be significantly more effective.
Winterhalter
Michael
M
Department of Anesthesiology, Hannover Medical School, Hannover, Germany. Winterhalter.Michael@mhhannover.de
Simon
Andre
A
Fischer
Stefan
S
Rahe-Meyer
Niels
N
Chamtzidou
Nicoletta
N
Hecker
Hartmut
H
Zuk
Janusz
J
Piepenbrock
Siegfried
S
Strüber
Martin
M
D000280:Administration, Inhalation; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000601:surgery*; D016285:Iloprost / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies
D009569:Nitric Oxide; D016285:Iloprost