A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients

作     者：Khan, Tanveer A. Schnickel, Gabriel Ross, David Bastani, Sam Laks, Hillel Esmailian, Fardad Marelli, Daniel Beygui, Ramin Shemin, Richard Watson, Larry Vartapetian, Irina Ardehali, Abbas 

作者机构：Univ Calif Los Angeles Sch Med Div Cardiothorac Surg Dept Surg Los Angeles CA 90095 USA Univ Calif Los Angeles Sch Med Div Pulm & Crit Care Med Dept Med Los Angeles CA 90095 USA 

出 版 物：《JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY》 (胸腔与心血管外科学杂志)

年 卷 期：2009年第138卷第6期

页      面：1417-1424页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：CI confidence interval CVP central venous pressure F io 2 inspired oxygen fraction NO nitric oxide PA pulmonary artery Pa o 2 arterial oxygen tension PGD primary graft dysfunction PGI2 prostacyclin RV right ventricular Sv o 2 venous oxygen saturation 

摘      要：Objective: Inhaled nitric oxide has been shown to reduce pulmonary vascular resistance in patients undergoing cardiothoracic surgery, but it is limited by toxicity, the need for special monitoring, and cost. Inhaled prostacyclin also decreases pulmonary artery pressure, is relatively free of toxicity, requires no specific monitoring, and is less expensive. The objective of this study was to compare nitric oxide and prostacyclin in the treatment of pulmonary hypertension, refractory hypoxemia, and right ventricular dysfunction in thoracic transplant recipients in a prospective, randomized, crossover pilot trial. Methods: Heart transplant and lung transplant recipients were randomized to nitric oxide or prostacyclin as initial treatment, followed by a crossover to the other agent after 6 hours. Pulmonary vasodilators were initiated in the operating room for pulmonary hypertension, refractory hypoxemia, or right ventricular dysfunction. Nitric oxide was administered at 20 ppm, and prostacyclin was administered at 20,000 ng/mL. Hemodynamic and oxygenation parameters were recorded before and after initiation of pulmonary vasodilator therapy. At 6 hours, the hemodynamic and oxygenation parameters were recorded again, just before discontinuing the initial agent. Crossover baseline parameters were measured 30 minutes after the initial agent had been stopped. The crossover agent was then started, and the hemodynamic and oxygenation parameters were measured again 30 minutes later. Results: Heart transplant and lung transplant recipients (n = 25) were randomized by initial treatment (nitric oxide, n = 14;prostacyclin, n = 11). Nitric oxide and prostacyclin both reduced pulmonary artery pressure and central venous pressure, and improved cardiac index and mixed venous oxygen saturation on initiation of therapy. More importantly, at the 6-hour crossover trial, there were no significant differences between nitric oxide and prostacyclin in the reduction of pulmonary artery pressure