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13. Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation

Author

Kemming, G. I., Merkel, M. J., Schallerer, A., Habler, O. P., Kleen, M. S., Haller, M., Briegel, J., Vogelmeier, C., Furst, H., Reichart, B., and Zwissler, B.

Subjects
Health care industry
Abstract

Byline: G. I. Kemming (1), M. J. Merkel (1), A. Schallerer (1), O. P. Habler (1), M. S. Kleen (1), M. Haller (1), J. Briegel (1), C. Vogelmeier (3), H. Furst (4), B. Reichart (5), B. Zwissler (1) Keywords: Key words Lung transplantation; Inhaled vasodilators; Nitric oxide; Pulmonary hypertension; Selective pulmonary vasodilation; Reperfusion injury Abstract: Objective: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantion. Design: Prospective clinical dose- response study. Setting: Anesthesiological intensive care unit of a university hospital. Patients and participants: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO.sub.2/FIO.sub.2) of less than 13.3 kPa (100 mmHg). Interventions: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. Measurements and results: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p &lt 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO.sub.2 increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO.sub.2), all were subject to long-term inhalation (1--19 days). All were successfully weaned from NO and were discharged from the intensive care unit. Conclusion: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation. Author Affiliation: (1) Department of Anesthesiology, Ludwig-Maximilians-Universitat Munchen, Klinikum Grosshadern, Marchioninistrasse 15, D-81 377 Munchen, Germany e-mail: bernhard.zwissler@ana.med.uni-muenchen.de Tel. + 49 (89) 7095-3417 Fax + 49 (89) 7095--8886, DE (2) Department of Surgical Research, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (3) Department of Internal Medicine, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (4) Department of Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (5) Department of Cardiac Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE Article note: Received: 23 February 1998 Accepted: 20 August 1998

Published
1998

14. PEEP only partly restores disturbed distribution of regional pulmonary blood flow in lung injury

Author

Kleen, M., Zwissler, B., and Mesmmer, K.

Subjects
Blood flow -- Physiological aspects, Lungs -- Injuries, Noradrenaline -- Physiological aspects, Biological sciences
Abstract

Research was conducted to examine the influence of lung injury, positive end-expiratory pressure and norepinephrine on the heterogeneity of regional pulmonary blood flow. An eight-channel recorder was utilized to monitor heart rate, right and left ventricular pressures while regional perfusion was determined with the reference sample method. Results indicated that oleic acid and glass bead-induced lung injury leads to to an abnormal distribution of regional pulmonary blood flow.

Published
1998

23. The effect of bleaching on the surface chemistry of mechanical pulps

Author

Kangas, H. and Kleen, M.

Subjects
Fibers, Chemistry, Mechanical pulps, genetic structures, Peroxide bleaching, Surface properties, Bleaching, Fines, sense organs, skin and connective tissue diseases, Analysis
Abstract

The aim of this work was to obtain knowledge on how peroxide bleaching anddithionite bleaching change the surface chemistry of mechanical pulps, as well as of isolated fibres and fines, by using chemical analysis in combination with two surface-sensitive spectroscopic methods, ESCA (Electron Spectroscopy for Chemical Analysis) and ToF-SIMS (Time-of-Flight Secondary Ion Mass Spectrometry). The changes in the surface chemistry induced by bleaching depended on the bleaching chemical, pulp type and pulp fraction. Peroxide bleaching resulted in greater changes in the surface chemistry than dithionite. Peroxide bleaching removed extractives more effectively from CTMP than from TMP, but changes were less obvious for CTMP fines than for TMP fines. The surface of fibrils, in particular, was changed during bleaching due to removal or deposition of extractives. Fibres and flakes underwent similar changes in their surface chemistry. ToF-SIMS and ESCA gave complementary information about the surface chemistry of mechanical pulps and pulp fractions.

Published
2008

26. Fiber surface composition and its relations to papermaking properties of soda-anthrapuinone and kraft pulps

Author

Sjöberg, John, Kleen, M., Dahlman, O., Agnemo, R., Sundvall, H., Sjöberg, John, Kleen, M., Dahlman, O., Agnemo, R., and Sundvall, H.

Abstract

The development of paper strength properties during chlorine dioxide ECF and alkaline peroxide TCF bleaching of kraft and soda-AQ pulps and the relation to the chemical composition of the fiber surface and inner layers was investigated. Surface and inner fiber wall layer materials were collected by mechanical peeling and analyzed by enzymatic hydrolysis and capillary electrophoretic analysis for carbohydrates and pyrolysis combined with gas chromatography and mass spectrometry for lignin. The surface layers of the fibers revealed greater chemical changes by bleaching operations than did the inner layers. Handsheets were produced and tested for strength. Correlation was found between the tensile index and hemicellulose content of the fiber surface layer., QC 20141205

Published
2004
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42. Letter

Author

Kleen, M., primary, Habler, O., additional, and Messmer, K., additional

Published
1998
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