Inhaled nitric oxide does not prevent postpneumonectomy pulmonary edema in pigs
2007 The American Association for Thoracic Surgery
Marc Filaire, MDa, Elie Fadel, MDb, Benoît Decanteb, Frédéric Seccatoreb, Guy-Michel Mazmanian, MDb, Philippe Hervé, MDb,*
a CHU Clermont-Ferrand, Service de Chirurgie Générale et Thoracique, Hôpital Gabriel Montpied, and Université d’Auvergne, Laboratoire d’Anatomie, Clermont-Ferrand, Franceb Experimental Surgery Laboratory and Department of Thoracic and Vascular Surgery and Heart-Lung transplantation, Centre Chirurgical Marie Lannelongue, Paris-Sud University, Le Plessis-Robinson, France.
Received for publication May 11, 2006; revisions received July 22, 2006; accepted for publication September 5, 2006.
* Address for reprints: Philippe Hervé, MD, Centre Chirurgical Marie Lannelongue, Paris-Sud University, Le Plessis-Robinson, France. (Email: firstname.lastname@example.org)
Objective: Increase in lung permeability is an inevitable consequence of pneumonectomy in relation to inflammatory injury and increased perfusion flow. We tested whether inhaled nitric oxide, a potent vasodilatator and anti-inflammatory agent, prevents postpneumonectomy edema in the first 24 hours after pneumonectomy in pigs.
Methods: We assessed hemodynamics, gas exchange, extravascular lung water estimated with the double-indicator dilution method, and lung neutrophil sequestration measured on the basis of lung myeloperoxidase activity at 1 and 24 hours after left pneumonectomy in 14 pigs randomly assigned to inhaled nitric oxide (10 ppm) or control groups.
Results: Extravascular lung water content markedly increased at 1 and 24 hours after pneumonectomy, with no difference between the 2 groups. Hemodynamics did not differ between the 2 groups. Myeloperoxidase activity was higher and PaO 2 values were lower in the nitric oxide group compared with in the control group.
Conclusions: Over the 24 hours after pneumonectomy, intraoperative inhaled nitric oxide levels neither improved gas exchange nor attenuated accumulation of lung water. On the contrary, they were associated with an increase in lung neutrophil sequestration and deterioration of arterial oxygenation, suggesting the occurrence of an early and toxic effect of nitric oxide.
Abbreviations and Acronyms: CI = cardiac index; EVLW = extravascular lung water; FIO 2 = inspired oxygen fraction; MPAP = mean pulmonary artery pressure; MPO = myeloperoxidase; MSAP = mean systemic artery resistance; NO = nitric oxide; PBV = pulmonary blood volume; SVRI = indexed value of systemic vascular resistance