Effect of Nebulised Iloprost Combined With Inhaled Nitric Oxide and Oral Sildenafil on Lung Transplant Patients. Therapeutic Efficacy in Pulmonary Hypertension During Surgery

Objectives: There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. Patients and methods: Seventeen patients received 10 mu g of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50 mmHg. All the patients received 50 mg of oral sildenafil 30 min before anaesthetic induction, 20 ppm of inhaled nitric oxide after tracheal intubation. The haennodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30 min after it was given. Results: The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac index and the right ventricular ejection fraction. There were no significant changes occurred in the systemic arterial pressure. Conclusions: The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation. (C) 2011 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del dolor. Published by Elsevier Espana, S.L. All rights reserved.