J Korean Soc Transplant.  2014 Dec;28(4):250-253. 10.4285/jkstn.2014.28.4.250.

Improvement of Hypoxemia by Inhaled Nitric Oxide Gas Therapy in Potential Deceased Donor

• Park MJ
• Yun HJ
• Lee KH
• Cho AR
• Choi IS
• Moon JI
• Yoon SH
• Hwang WM
• Yun SR

• KMID: 1941322
• DOI: http://doi.org/10.4285/jkstn.2014.28.4.250

Abstract

Potential diseased donors manifest altered physiological changes associated with pulmonary edema, profound hemodynamic and metabolic abnormalities. These derangements may be more significant after apnea tests which result in severe hypoxemia and cardiovascular complications. Nitric oxide (NO) inhalation therapy can be applied following apnea tests in the brain-dead donor whose ventilator support has been maintained with high positive end-expiratory pressure. Inhalation of NO gas causes selective dilation of blood vessels in only those lung segments that are actively participating in gas exchange (oxygen and carbon dioxide) at the alveolar capillary level. In other words, this increases the blood flow to areas of the lung where oxygen is being provided and thus improves oxygen levels in the body. We report on the case of a 14-year-old organ donor with inhaled NO therapy after apnea testing. The duration of NO inhalation therapy was 14 hours. This deceased donor, who suffered with severe hypoxemia and hemodynamic instability after apnea tests, improved after NO gas therapy and adequate vasoactive drugs. NO gas therapy will be helpful for improving oxygen delivery to pulmonary vessels. Two kidneys and one liver were successfully retrieved from donors. These recipients had well preserved function of allografts. Therefore, NO inhalation can be helpful in improvement of hypoxemia and increasing organ availability in deceased organ donors.

Keyword

Nitric oxide; Brain death; Anoxia; Organ transplantation

MeSH Terms

Adolescent
Allografts
Anoxia*
Apnea
Blood Vessels
Brain Death
Capillaries
Carbon
Hemodynamics
Humans
Inhalation
Kidney
Liver
Lung
Nitric Oxide*
Organ Transplantation
Oxygen
Positive-Pressure Respiration
Pulmonary Edema
Respiratory Therapy
Tissue Donors*
Ventilators, Mechanical
Carbon
Nitric Oxide
Oxygen

Figure

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  Fig. 1. Chest X-ray at arrival to hospital based organ procurement organization.

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  Fig. 2. Chest X-ray after nitric oxide supply.

Reference

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