Inhaled Nitric Oxide

Rich, George F.; Murphy, Gerald D.; Roos, C. M.; Johns, Roger A.

doi:10.1097/00000542-199306000-00004

Cited by 205 publications

(8 citation statements)

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“…This minimizes systemic vasodilatation, although it necessitates continuous delivery into the ventilator circuit [206]. NO selectively reduces PVR and improves CO in PAH [212], secondary PH [205,213,214], acute PE [215,216], ischemic RV dysfunction [217,218], and postsurgical PH [202,219-234]. NO also improves oxygenation [235], RVEF, and reduces vasopressor requirements in PH after cardiac surgery [236], especially in patients with higher baseline PVR [237], with no augmented effect seen at doses above 10 ppm in these patients [238].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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“…In another study nitric oxide in a concentration of 20 p.p.m. had no effect on P a O 2 , while PVR decreased in patients undergoing CABG or mitral valve replacement (Rich et al . 1993).…”

Section: Discussionmentioning

confidence: 99%

Decreased pulmonary vascular resistance during nasal breathing: modulation by endogenous nitric oxide from the paranasal sinuses

Settergren

Angdin

Astudillo

et al. 1998

Acta Physiologica Scandinavica

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Nitric oxide is present in high concentration in the human nasal airways. During inspiration through the nose a bolus is transported to the lungs. In a randomized cross-over study the effect of two different patterns of breathing, nasal breathing and mouth breathing, was evaluated in 10 patients (mean age 65 years), breathing room air the morning of the first post-operative day after open heart surgery. Nasal breathing is defined as inspiration through the nose and expiration through the mouth, whilst mouth breathing is the converse of this: inspiration through the mouth and expiration through the nose. Pressure in the pulmonary artery and left atrium or pulmonary artery wedge was measured together with thermodilution cardiac output and arterial and mixed venous oxygenation and acid-base parameters. Pulmonary vascular resistance index (PVRI), venous admixture and alveolar-arterial gradient were calculated. Nasal breathing resulted in a lower PVRI, 256 dyn s cm-5 cm-2 vs. 287 (P < 0.01). The oxygen and carbon dioxide tension and pH of arterial and mixed venous blood, venous admixture and the alveolar-arterial gradient remained unchanged. The decreased level of PVRI during nasal breathing compared to that during mouth breathing supports the notion, that endogenous nitric oxide acts as an airborne messenger to modulate the pulmonary vascular tone during normal breathing.

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“…In a study, it was concluded that iNO greatly decreases mPAP in patients with postoperative PH, helps with vasodilation, and does not cause hemodynamic complications (Figure 3). 145 Furthermore, studies have shown that when administering iNO to adults undergoing cardiac surgery, iNO reduces pulmonary arterial pressure and PVR without reducing systemic vascular resistance and systemic arterial pressure 146–151 . Additionally, iNO was found to be more effective in treating PH after cardiac surgery than intravenous (IV) vasodilators but not necessarily more effective than IV prostaglandin E1 152 …”

Section: Resultsmentioning

confidence: 99%

“…145 Furthermore, studies have shown that when administering iNO to adults undergoing cardiac surgery, iNO reduces pulmonary arterial pressure and PVR without reducing systemic vascular resistance and systemic arterial pressure. [146][147][148][149][150][151] Additionally, iNO was found to be more effective in treating PH after cardiac surgery than intravenous (IV) vasodilators but not necessarily more effective than IV prostaglandin E1. 152 iNO has also been demonstrated to be promising in treating PH due to mitral valve surgery.…”

Section: Inhaled No (Ino)mentioning

confidence: 99%

Pulmonary hypertension associated with cardiopulmonary bypass and cardiac surgery

Fayad

Sellke

Feng

2022

Journal of Cardiac Surgery

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Background and Aim Pulmonary hypertension (PH) is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass (CPB). The purpose of this review is to explain the characteristics of PH, the mechanisms of PH induced by cardiac surgery and CPB, treatments for postoperative PH, and future directions in treating PH induced by cardiac surgery and CPB using up‐to‐date findings. Methods The PubMed database was utilized to find published articles. Results There are many mechanisms that contribute to PH after cardiac surgery and CPB which involve pulmonary vasomotor dysfunction, cyclooxygenase, the thromboxane A2 and prostacyclin pathway, the nitric oxide pathway, inflammation, and oxidative stress. Furthermore, there are several effective treatments for postoperative PH within different types of cardiac surgery. Conclusions By possessing a deep understanding of the mechanisms that contribute to PH after cardiac surgery and CPB, researchers can develop treatments for clinicians to use which target the mechanisms of PH and ultimately reduce and/or eliminate postoperative PH. Additionally, learning about the most up‐to‐date studies regarding treatments can allow clinicians to choose the best treatments for patients who are undergoing cardiac surgery and CPB.

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Inhaled Nitric Oxide

Cited by 205 publications

References 0 publications

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Decreased pulmonary vascular resistance during nasal breathing: modulation by endogenous nitric oxide from the paranasal sinuses

Pulmonary hypertension associated with cardiopulmonary bypass and cardiac surgery

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