A retrospective analysis of nitric oxide inhalation in patients with severe acute lung injury in Sweden and Norway 1991–1994

Luhr, O.; Nathorst-Westfelt, U.; Lundin, S.; Wickerts, Carl-Johan; Stiernström, Hans; Berggren, Lars; Aardal, S.; Johansson, L. A.; Stenqvist, O.; Rudberg, Ulf; Lindh, Annika; Bindslev, L.; Martling, Claes‐Roland; Hornbaek, V.; Frostell, Claes

doi:10.1111/j.1399-6576.1997.tb04639.x

Cited by 10 publications

(2 citation statements)

References 31 publications

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“…Early in the histopathological evolution of ARDS, pulmonary vasoconstriction, thromboembolism, and interstitial edema contribute to the development of PH, although pulmonary vascular remodeling probably occurs eventually [22]. Many patients with severe ALI do not respond to NO inhalational therapy with alleviation of PAH and hypoxemia, so this treatment remains controversial [23].…”

Section: Acute Pahmentioning

confidence: 99%

The Management of Acute Pulmonary Arterial Hypertension

Gan

2010

Cardiovascular Therapeutics

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Acute pulmonary arterial hypertension (PAH), which may complicate the course of many complex disorders, is always underdiagnosed and its treatment frequently begins only after serious complications have developed. Acute PAH is distinctive because they differ in their clinical presentation, diagnostic findings, and response to treatment from chronic PAH. The acute PAH may take either the form of acute onset of chronic PAH or acute PAH or surgeryrelated PAH. Significant pathophysiologic differences existed between acute and chronic PAH. Therapy of acute PAH should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. There are three classes of drugs targeting the correction of abnormalities in endothelial dysfunction, which have been approved recently for the treatment of PAH: (1) prostanoids; (2) endothelin receptor antagonists; and (3) phosphodiesterase-5 inhibitors. The efficacy and safety of these compounds have been confirmed in uncontrolled studies in patients with PAH. Intravenous epoprostenol is suggested to serve as the first-line treatment for the most severe patients. In the other situations, the first-line therapy may include bosentan, sildenafil, or a prostacyclin analogue. Recent advances in the management of PAH have markedly improved prognosis.Pulmonary arterial hypertension (PAH) is a progressive, symptomatic, and ultimately fatal disorder for which substantial advances in treatment have been made during the past decade [1]. Despite advances in the management of PAH, the mortality rate remains excessive. Acute PAH, which may lead to refractory systemic arterial hypotension, severe hypoxemia, right ventricular (RV) dysfunction and failure, and ultimately result in cardiogenic and/or obstructive shock and death have always been neglected until serious complications have developed. Effective management requires timely recognition and accurate diagnosis of the disorder and appropriate selection among therapeutic alternatives. Despite progress in treatment, obstacles remain that impede the achievement of optimal outcomes [2]. The pathophysiology, monitoring, and management of the acute pulmonary hypertension are reviewed in this article to highlight the importance and due management of it. The article also reviews established approaches to evaluation and treatment, with emphasis on the appropriate application of calcium channel blockers (CCBs), prostacyclin analogues, endothelin receptor antagonists (ETRAs), and phosphodiesterase 5 inhibitors. Pathophysiology and Pathogenesis of Acute PAHPAH is characterized by elevated pulmonary arterial pressure (PAP) and secondary RV failure. The definition of PAH used in clinical trials has been a mean pulmonary arterial pressure (mPAP) >25 mmHg at rest or >30 mmHg with exercise, a pulmonary capillary wedge pressure (PCWP) of <15 mmHg, and a pulmonary vascular resistance (PVR) of >3 Wood units, which has been attributed to the criteria for idiopathic PAH established by the National Institutes of Health Regis...

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Section: Acute Pahmentioning

confidence: 99%

The Management of Acute Pulmonary Arterial Hypertension

Gan

2010

Cardiovascular Therapeutics

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“…Recently, the use of inhaled nitric oxide (NOi) in patients with impaired gas exchange or pulmonary hypertension was suspended in Sweden on the basis of a meta-analysis showing higher mortality in the group of patients treated with NOi than in the control group [4]. This demonstrates that the mainly convincing concept of NOi as treatment of these disorders needs further careful evaluation.…”

Section: Introductionmentioning

confidence: 97%

Dosage of inhaled nitric oxide: a simple method for experimental studies

et al. 1999

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Few studies on treatment with inhaled nitric oxide (NOi) have been carried out in small laboratory animals yet, since commercially available dosing devices are not appropriate in this setting for technical or financial reasons. The aim of our study was to establish and validate a simple, cost-effective system for the application of NOi in small animals. The system mixes NOi with constant-flow inspiratory gas. A gas blender allows for a mixture of nitrogen, oxygen, and NO dissolved in nitrogen. A formula using the desired inspiratory oxygen fraction and the desired concentration of NOi as independent variables derives a somewhat higher inspiratory oxygen fraction, which is preset using an oximeter. Then the flow of NO in nitrogen is started, lowering the inspiratory oxygen fraction to the initially desired value, thereby adding NOi in the desired concentration. The method was validated by 153 adjustments, covering a variety of oxygen fractions and concentrations of NOi. NOi was measured by chemiluminescence as reference method. A close correlation (R = 0.994) was found, and the regression line was close to the line of identity with y = -0.0994 + 1.048x. No systematic errors could be identified. We conclude that the method described may serve as a simple, cost-effective way to administer NOi to small animals.

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Acute Respiratory Failure

Gurka¹,

Balk²

2008

Critical Care Medicine

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A retrospective analysis of nitric oxide inhalation in patients with severe acute lung injury in Sweden and Norway 1991–1994

Cited by 10 publications

References 31 publications

The Management of Acute Pulmonary Arterial Hypertension

The Management of Acute Pulmonary Arterial Hypertension

Dosage of inhaled nitric oxide: a simple method for experimental studies

Acute Respiratory Failure

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