Assessing the nitric oxide efficacy in bilateral lung transplantation

Background. One of the most frequent and severe complications in the early postoperative period in lung transplantation is primary graft dysfunction resulting from ischemia-reperfusion injury. There is evidence of the effectiveness of using inhaled nitric oxide in order to prevent such injury.

Objective. To assess the effectiveness of nitric oxide in the intra- and early postoperative period in bilateral lung transplantation.

Material and methods. We examined 43 patients who underwent bilateral lung transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2012-2021. The patients were divided into two groups. The study group consisted of 23 patients, whose complex of treatment included the use of inhaled nitric oxide. Patients in the comparison group (n=20) received a standard therapy. The end points of the study were: the mechanical ventilation duration, the frequency of using extracorporeal membrane oxygenation and its duration, mortality, dynamics of oxygenation index, blood lactate level, pH, base deficiency.

Results. The use of inhaled nitric oxide therapy in patients in the intra- and early postoperative period during lung transplantation improved the ventilation-perfusion ratio, as evidenced by an increase in the oxygenation index by 1.1 times (p=0.128) and 1.3 times (p=0.026) at 48 and 72 hours after surgery, respectively. Meanwhile, the frequency of using extracorporeal membrane oxygenation during surgery was found to decrease by 1.2 times (p=0.033), and that after surgery decreased by 1.4 times (p=0.474); the mechanical ventilation duration decreased by 1.4 times (p=0.042); the duration of extracorporeal membrane oxygenation decreased by 1.6 times (p=0.028); mortality reduced by 8%.

Conclusion. The use of inhaled nitric oxide therapy for lung transplantation had a positive effect on the intra- and early postoperative period, as indicated by an improvement in blood gas parameters, a reduction in the frequency and duration of veno-arterial extracorporeal membrane oxygenation, and the duration of mechanical ventilation.

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