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

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 adminis- tration on pulmonary hemodynamics and oxygenation during lung transplantation. Methods. Eighteen patients undergoing lung transplantation were enrolled in this study. During the first lung implan- tation, 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 oxygena- tion 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.