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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2008 Novembre;74(11):627-33
Inhaled areosolized prostaglandin E1, pulmonary hemodynamics, and oxygenation during lung transplantation
Della Rocca G. 1, Coccia C. 1, Pompei L. 1, Costa M. G. 1, Di Marco P. 2, Pietropaoli P. 2
1 Department of Anesthesia and Intensive Care, University of Udine, Udine, Italy;
2 Department of Anesthesia and Intensive Care, University of Rome “La Sapienza”, Rome, Italy
Background. The use of inhaled aerosolized prostaglandin E1 (aerPGE1), a pulmonary vasodilator, has not been widely analyzed. In contrast to prostacyclin, PGE1 has a shorter lifetime and is metabolized in a greater amount from the lungs, lowering the risk of systemic effects. The aim of this study was to analyse the effects of aerPGE1 administration on pulmonary hemodynamics and oxygenation during lung transplantation.
Methods. Eighteen patients undergoing lung transplantation were enrolled in this study. During the first lung implantation, systemic and pulmonary hemodynamic and oxygenation data were evaluated in three phases: baseline – in 100% O2; during aerPGE1 – after 15 min of aerosolized prostaglandin E1 administration in 100% O2; after aerPGE1 – 15 min after the end of the prostaglandin E1 administration in 100% O2.
Results. During aerPGE1 a reduction in mPAP, PVRI, and Qs/Qt and an increase in PaO2/FiO2 were observed. Soon after prostaglandin inhalation was ceased, the mPAP, the PVRI, and the Qs/Qt increased while PaO2/FiO2 decreased. During the study, no significant difference in systemic pressure among the phases was noted. A high correlation between changes in mPAP, Qs/Qt and PaO2/FiO2 after aerPGE1 administration and baseline values was observed. ROC curve analysis showed that values of 40 mmHg of mPAP, 21.7% of the pulmonary shunt, and 364 mmHg for PaO2/FiO2 predict a decrease in mean pulmonary arterial pressure and pulmonary shunt or an improvement in oxygenation of 10% with respect to baseline values.
Conclusion. A low dose of aerosolized prostaglandin E1 decreases pulmonary arterial pressure and improves oxygenation without impairment on systemic hemodynamics, also during anesthesia for lung transplantation. The effect seems to depend on baseline values, which can be considered to be a predictor of the prostaglandin response.