Inhaled nitric oxide in postpneumonectomy pulmonary edema

Introduction

The one published case series detailing the use of inhaled nitric oxide (INO) in acute respiratory distress syndrome after lung resection found a 31% increase in oxygenation associated with a 70% survival [1]. The total cost of INO therapy if using commercial INO was approximately $500,000. This abstract details our experience with the use of INO in postpneumonectomy pulmonary edema (PPPE).

Methods

We retrospectively reviewed the charts of all PPPE patients between 1994 and 2001 who received INO. Outcomes and physiological endpoints including P/F ratio, pulmonary artery pressures and PEEP were analyzed.

Results

There were nine right-sided and one left-sided pneumonectomy patients. There were five deaths, all directly related to PPPE. There were no complications from the use of INO. The approximate total commercial cost of the INO was $108,700. Figure 1 demonstrates the change in mean PaO₂/FiO₂ ratio, pulmonary artery pressure, positive end expiratory pressure and INO concentration.

Figure 1

Discussion

The increased PaO₂/FiO₂ ratio was similar to the previous report, with minimal change in mean PEEP. Mean pulmonary artery pressure did not increase during INO therapy. The mean INO concentration was 10 ppm. Although promising with respect to physiological endpoints, considering the expense of INO and equivocal outcome, a randomized control trial of the use of INO in this condition is needed.