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American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1483-1489, (2003)
© 2003 American Thoracic Society

Original Article

A Randomized Trial of Inhaled Nitric Oxide to Prevent Ischemia–Reperfusion Injury after Lung Transplantation

Maureen O. Meade, John T. Granton, Andrea Matte-Martyn, Karen McRae, Bruce Weaver, Paula Cripps and Shaf H. Keshavjee the Toronto Lung Transplant Program

Toronto Lung Transplant Program, Toronto General Hospital, University of Toronto; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Correspondence and requests for reprints should be addressed to J. T. Granton, M.D., FRCPC, Toronto General Hospital, 200 Elizabeth Street, EN 10-220, Toronto, ON, M5G 2C4 Canada. E-mail: john.granton{at}uhn.on.ca

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.

Key Words: nitric oxide • lung transplantation • mechanical ventilation • critical care




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