{"id":21131,"date":"2022-03-05T05:26:00","date_gmt":"2022-03-04T21:26:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21131"},"modified":"2022-03-05T06:10:00","modified_gmt":"2022-03-04T22:10:00","slug":"jama-surg%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%88%90%e4%ba%ba%e8%82%ba%e7%a7%bb%e6%a4%8d%e6%82%a3%e8%80%85%e7%9a%84%e5%90%b8%e5%85%a5%e8%82%ba%e5%8a%a8%e8%84%89%e6%89%a9%e5%bc%a0%e5%89%82","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21131","title":{"rendered":"[JAMA Surg\u53d1\u8868\u8bba\u6587]\uff1a\u6210\u4eba\u80ba\u79fb\u690d\u60a3\u8005\u7684\u5438\u5165\u80ba\u52a8\u8109\u6269\u5f20\u5242\u6cbb\u7597"},"content":{"rendered":"\n

Original Investigation November 17, 2021<\/p>\n\n\n\n

Inhaled Pulmonary Vasodilator Therapy in Adult Lung Transplant: A Randomized Clinical Trial<\/h1>\n\n\n\n

Kamrouz\u00a0Ghadimi,\u00a0Jhaymie\u00a0Cappiello,\u00a0Mary\u00a0Cooter-Wright,\u00a0et al<\/h3>\n\n\n\n

JAMA Surg.\u00a0<\/em>2022;157(1):e215856. doi:10.1001\/jamasurg.2021.5856<\/h3>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Inhaled nitric oxide (iNO) is commonly administered for selectively inhaled pulmonary vasodilation and prevention of oxidative injury after lung transplant (LT). Inhaled epoprostenol (iEPO) has been introduced worldwide as a cost-saving alternative to iNO without high-grade evidence for this indication.<\/p>\n\n\n\n

Objective<\/strong>  To investigate whether the use of iEPO will lead to similar rates of severe\/grade 3 primary graft dysfunction (PGD-3) after adult LT when compared with use of iNO.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This health system\u2013funded, randomized, blinded (to participants, clinicians, data managers, and the statistician), parallel-designed, equivalence clinical trial included 201 adult patients who underwent single or bilateral LT between May 30, 2017, and March 21, 2020. Patients were grouped into 5 strata according to key prognostic clinical features and randomized per stratum to receive either iNO or iEPO at the time of LT via 1:1 treatment allocation.<\/p>\n\n\n\n

Interventions<\/strong>  Treatment with iNO or iEPO initiated in the operating room before lung allograft reperfusion and administered continously until cessation criteria met in the intensive care unit (ICU).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was PGD-3 development at 24, 48, or 72 hours after LT. The primary analysis was for equivalence using a two one-sided test (TOST) procedure (90% CI) with a margin of 19% for between-group PGD-3 risk difference. Secondary outcomes included duration of mechanical ventilation, hospital and ICU lengths of stay, incidence and severity of acute kidney injury, postoperative tracheostomy placement, and in-hospital, 30-day, and 90-day mortality rates. An intention-to-treat analysis was performed for the primary and secondary outcomes, supplemented by per-protocol analysis for the primary outcome.<\/p>\n\n\n\n

Results<\/strong>  A total of 201 randomized patients met eligibility criteria at the time of LT (129 men [64.2%]). In the intention-to-treat population, 103 patients received iEPO and 98 received iNO. The primary outcome occurred in 46 of 103 patients (44.7%) in the iEPO group and 39 of 98 (39.8%) in the iNO group, leading to a risk difference of 4.9% (TOST 90% CI, \u20136.4% to 16.2%; P<\/em>\u2009=\u2009.02 for equivalence). There were no significant between-group differences for secondary outcomes.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among patients undergoing LT, use of iEPO was associated with similar risks for PGD-3 development and other postoperative outcomes compared with the use of iNO.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov identifier: NCT03081052<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation November 17, 2021 Inhaled P […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21131"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21131"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21131\/revisions"}],"predecessor-version":[{"id":21423,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21131\/revisions\/21423"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21131"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21131"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}