The aim of the study was to evaluate the effectiveness of a new technology for the use of inhaled nitric oxide (NO) for the heart and lung protection during operations with cardiopulmonary bypass (СРВ). Materials and Methods. The study included 90 patients who underwent heart valve surgery and combined procedures under CPB and pharmacological cardioplegia. Three groups were created: group 1 (control, n=30); group 2 (n=30) — NO inhalation (20 ppm) was conducted traditionally, that is, before and after CPB; group 3 (n=30) — NO inhalation was performed using a new technology — during the entire operation, with pulmonary artery perfusion and lung ventilation performed during CPB. Troponin I (cTn I) level, changes in the pulmonary function parameters, and clinical indicators were studied. Results. Statistically significant lower levels of postoperative cTn I were registered in the patients of groups 2 and 3, at the same time, the levels were significantly lower in group 3 compared to group 2. The patients in group 1 (standardized anesthesia protocol) demonstrated an increase in the alveolar-arterial oxygen difference, an increase in intrapulmonary shunting, a decrease in blood oxygenation, and static lung compliance after СРВ. In both cases, NO inhalation retained the values of lung compliance and pulmonary oxygenating function after CPB, and in the patients of group 3, it also significantly reduced intrapulmonary shunting and alveolar-arterial difference after CPB. NO inhalation allowed a statistically significant decrease in the incidence of pulmonary dysfunction, acute respiratory failure, as well as the time of respiratory support in the ICU. Conclusion. The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.

No abstract

No abstract

Introduction. Usually, gaseous nitric oxide (NO) is supplied to the patient by inhalation, adding to the inhaled gas mixture during spontaneous breathing, or supplying it to the inspiratory part of the ventilator. It is believed that the main point of its action is the pulmonary vasculature, where it exhibits an expanding effect, thus improving the oxygenation of arterial blood and reducing the pulmonary artery pressure. However, data from recent experimental clinical studies suggest that the addition of NO directly to the gas mixture supplied to the oxygenator makes it possible to systemically deliver NO into the bloodstream and, thereby, reduce the inflammatory response of the whole body caused by the extracorporeal circuit (cardiopulmonary bypass [CPB] or extracorporeal membrane oxygenation [ECMO]). Materials and methods. The search for publications was carried out in electronic databases PubMed, EMBASE. The last search term was December 30, 2020. The search term included the following words: “nitric oxide” and “artificial circulation” or “ECMO”. Only experimental and clinical randomized controlled blinded studies were selected for inclusion in the review. Results. The article analyzes data from recent studies related to the delivery of gaseous NO to the extracorporeal circuit, among which the issues of both NO delivery into the cardiopulmonary bypass line and the systemic and organ effects of nitric oxide delivered to the circuit are considered. The cardioprotective and anti-inflammatory effects of NO supplied to the extracorporeal circulation are considered in detail, as well as its effect on the lungs and kidneys. Conclusions. Further new randomized trials are needed to determine the place of the technology for supplying gaseous nitric oxide to the line of heart-lung machines or ECMO in modern cardiac surgery.

Objectives. To study clinical effectiveness and safety of the method of nitric oxide (NO) synthesized from atmospheric air in the postoperative period for children with precapillary pulmonary arterial hypertension (PAH). Materials and methods. There were 90 patients included into a single-center retrospective cohort study. 28 were newborns and 62 older than 28 days, 30 male and 50 female with a median age of 0.25 (0.28; 1.17) years. Inclusion criteria: informed consent, signed by the official representative, cardiac surgery, mechanical controlled/support ventilation, systolic pulmonary arterial pressure (PAPsys) > 35 mm Hg. Exclusion criteria: methemoglobinemia, heart failure III-IV NYHA, bleeding diathesis. 45 children in the study group were inhaled NO synthesized by АИТ-NO-01 device and the other 45 (retrospective control group) were inhaled NO from the cylinder via NOXBOX device (Bedfond, Great Britain). There were no significant difference between the groups in terms of anthropometric measures and initial precapillary PH. Results. After 1 hour of inhalation of NO by АИТ-NO-01 there PAPsys decreased by 33.3 % (p < 0.001). In the retrospective control group after 1 hour of NO inhalation PAPsys decreased by 26.7 % (p < 0.001). PAPsys decreased by more than 10 % in 89 % patients from the study group and 84 % of patients from the retrospective control group (p = 0.4). There were no significant influence of NO inhalation on the systemic hemodymanic (BP, HR, CVP) either with the use of АИТ-NO-01 or with the use of NO from the cylinder. The inhalation of NO synthesized by АИТ-NO-01 from the atmospheric air was associated with less invasive mechanical ventilation duration than when in the control group: 12 (2; 28) vs. 14 (12.2; 70.5) h; p = 0.01. Length of ICU stay and postoperative complications risks were comparable in both groups. There were no difference in NO therapy complications (methemoglobin and carbon dioxide production) either with delivery of synthesized NO or with cylinder NO use. Conclusions. Inhalation of NO after cardiac surgery in children with АИТ-NO-01 in as efficient and as safe as cylinder NO use.