iloprost and Cystic-Fibrosis

There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery.. Seventeen patients received 10μg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50mmHg. AU the patients received 50mg of oral sildenafil 30min before anaesthetic induction, 20ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30min after it was given.. The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac Índex and the right ventrícular ejection fractíon. There were no signíficant changes occurred in the systemic arterial pressure.. The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation.

Topics: Administration, Inhalation; Administration, Oral; Adult; Aged; Cystic Fibrosis; Dobutamine; Drug Therapy, Combination; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Iloprost; Intraoperative Complications; Lung Transplantation; Male; Middle Aged; Nebulizers and Vaporizers; Nitric Oxide; Norepinephrine; Piperazines; Preoperative Care; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

We describe a patient with cystic fibrosis, end-stage lung disease, and secondary pulmonary hypertension in whom aerosolized iloprost was effective in lowering pulmonary artery pressure and improving functional status, thus proving successful as a bridge to lung transplantation. Inhaled iloprost may be an efficient and selective approach to treat pulmonary hypertension related to end-stage obstructive pulmonary disease.

Topics: Administration, Inhalation; Adult; Cystic Fibrosis; Female; Humans; Hypertension, Pulmonary; Iloprost; Lung Transplantation; Nitric Oxide; Premedication; Respiratory Insufficiency; Vascular Resistance; Vasodilator Agents