Inhaled aerosolized prostaglandin E1, pulmonary hemodynamics, and oxygenation during lung transplantation

The use of inhaled aerosolized prostaglandin E(1) (aerPGE(1)), a pulmonary vasodilator, has not been widely analyzed. In contrast to prostacyclin, PGE(1) 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 aerPGE(1) administration on pulmonary hemodynamics and oxygenation during lung transplantation.

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% O(2); during aerPGE(1) -- after 15 min of aerosolized prostaglandin E(1) administration in 100% O(2); after aerPGE(1) -- 15 min after the end of the prostaglandin E(1) administration in 100% O(2).

During aerPGE(1) a reduction in mPAP, PVRI, and Qs/Qt and an increase in PaO(2)/FiO(2) were observed. Soon after prostaglandin inhalation was ceased, the mPAP, the PVRI, and the Qs/Qt increased while PaO(2)/FiO(2) 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 PaO(2)/FiO(2) after aerPGE(1) 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 PaO(2)/FiO(2) predict a decrease in mean pulmonary arterial pressure and pulmonary shunt or an improvement in oxygenation of 10% with respect to baseline values.

A low dose of aerosolized prostaglandin E(1) 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.