Inhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery

Snow, David; Gray, Stephen; Ghosh, Sunit; Foubert, L.; Oduro, A.; Higenbottam, T. W.; Wells, F. C.; Latimer, R.D.

doi:10.1093/bja/72.2.185

Cited by 70 publications

(27 citation statements)

References 27 publications

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“…6 However, Snow et al have reported that only diastolic PAP significantly decreased. 20 In the present study, there was only one case of previous valvular replacement surgery. Although only systolic PAP was evaluated, our results seemed to be comparable to previous reports.…”

Section: Discussionmentioning

confidence: 52%

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Inhaled Nitric Oxide in Patients With Pulmonary Hypertension Due to Valvular Heart Disease and Chronic Lung Disease

Sakane¹,

Ishimitsu²,

Ninomiya

et al. 1998

Jpn Circ J

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ince 1991, 1-3 the inhalation of nitric oxide (NO) has been used as one of the innovative treatments in patients with pulmonary hypertension (PH), especially for persistent pulmonary hypertension of the newborn 4,5 and for postoperative PH. [6][7][8] However, it is still unclear whether inhaled NO is effective for secondary PH and for chronic PH, which are caused by chronic heart and lung diseases, pulmonary vascular diseases, such as primary PH, and collagen disease. PH is caused by various conditions such as increased pulmonary vascular resistance (PVR), hypertrophy of the vascular wall due to increased pulmonary vascular flow (ie, ventricular septal defect) and vasoconstriction stimulated by the sympathetic nerve (ie, postoperative PH crisis). In the latter 2 conditions, it has been proved that NO inhalation is effective in reducing pulmonary artery pressure (PAP). However, in the chronic PH patients with high PVR, the endothelial cells have been injured, and the reaction to NO would be incomplete. Thus, each patient may show a variable response to the concentration and duration of the inhaled NO.Japanese Circulation Journal Vol.62, December 1998 The objective of this present study was to investigate the effects of NO inhalation on the hemodynamic status in chronic PH patients, especially in patients with chronic valvular heart disease. We hypothesized that the responses to NO inhalation were affected not only by the concentration of inhaled NO, but also by the background diseases that caused PH. Methods PatientsBetween September 1994 and March 1995, we evaluated 30 patients (17 men and 13 women, mean age 58±25 years) with PH caused by valvular heart diseases (n=8, group A), chronic lung disease (n=16, group B), or primary PH or PH due to collagen diseases (n=6, group C). The clinical diagnosis and characteristics of the patients are shown in Table 1. All patients had PH, which was identified by systolic pulmonary artery pressure (SPAP) being more than 27 mmHg calculated from the peak velocity of tricuspid valve regurgitation by Doppler echocardiography. This value was arbitrarily chosen because of the difficulty in determining the average pulmonary arterial pressure using echocardiography. The study was approved by the local committee (Approval Number. 10 & 11, Ethical Committee, University of Tsukuba). We also obtained a written informed consent from each patient. Nitric Oxide DeliveryNitric oxide gas, stored at 4000 ppm in nitrogen (N2) was mixed with room air in a mass flow meter (SEC-400MK3, Jpn Circ J 1998; 62: 877 -882 (Received December 5, 1997; revised manuscript received August 6, 1998; accepted August 20, 1998 The objective of this study was to investigate the effects of inhaled nitric oxide (NO) on chronic pulmonary hypertension (PH). Thirty patients with valvular heart diseases (n=8, group A), chronic lung diseases (n=16, group B), primary PH or PH due to collagen disease (n=6, group C) were studied. NO was delivered for 20 min at concentration of 5, 10, and 20 ppm in spontaneous respiration....

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Section: Discussionmentioning

confidence: 52%

“…6,20,21 Girard et al have shown that all SPAP, diastolic PAP, and mean PAP similarly decreased after valve replacement. 6 However, Snow et al have reported that only diastolic PAP significantly decreased.…”

Section: Discussionmentioning

confidence: 98%

Inhaled Nitric Oxide in Patients With Pulmonary Hypertension Due to Valvular Heart Disease and Chronic Lung Disease

Sakane¹,

Ishimitsu²,

Ninomiya

et al. 1998

Jpn Circ J

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“…In patients with adult respiratory distress syndrome (ARDS), predominant vasodilation occurred at pulmonary veins [40]. iNO does not affect cardiac output [41,42] and may [43,44] or may not improve RV function [5,45]. Reports on inotropic effects are contradictive [17,46].…”

Section: Inhalation Of Exogenous Nomentioning

confidence: 99%

“…There is a recent discussion on a possible negative inotropic effect of exogenous or endogenous NO. Endogenous NO has been reported to exert negativ inotropic effects in vitro [45]. In contrast, own experimental data do not give evidence for any negative effect of inhaled NO on myocardial contractility in vivo [17].…”

Section: Inhalation Of Exogenous Nomentioning

confidence: 99%

Searching the Ideal Inhaled Vasodilator: From Nitric Oxide to Prostacyclin

et al. 2002

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Today, the technique to directly administer vasodilators via the airway to treat pulmonary hypertension and to improve pulmonary gas exchange is widely accepted among clinicians. The flood of scientific work focussing on this new therapeutic concept had been initiated by a fundamental new observation by Pepke-Zaba [1]and Frostell in 1991 [2]: Both scientists reported, that inhalation of exogenous nitric oxide (NO) gas selectively dilates pulmonary vessels without a concomittant systemic vasodilation. No more than another decade ago NO was identified as an important endogenous vasodilator [3]while having merely been regarded an environmental pollutant before that time. Although inhaled NO proved to be efficacious, alternatives were sought-after due to NO’s potential side-effects. In search for the ideal inhaled vasodilator another group of endogenous mediators – the prostanoids – came into the focus of interest. The evidence for safety and efficacy of inhaled prostanoids is – among a lot of other valuable work – based on a series of experimental and clinical investigations that have been performed or designed at the Institute for Surgical Research under the guidance and mentorship of Prof. Dr. med. Dr. h.c. mult. K. Messmer [4-19]. In the following, the current and newly emerging clinical applications of inhaled prostanoids and the experimental data which they are based on, will be reviewed.

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“…Eine Senkung des PAP durch iNO fand sich auch nach koronarer Bypassoperation [60,146,172] [179]. Auch zum "bridging" bis zur Lungentransplantation wurde iNO in der Vergangenheit erfolgreich eingesetzt [171].…”

Section: Copd Und Asthma Bronchialeunclassified

Inhalierte Vasodilatatoren

Zwißler¹

2002

Anaesthesist

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First reports on the use of inhaled nitric oxide (NO) in patients were published in 1991. These reports confirmed data from animal experiments which suggested a selective vasodilatory effect of inhaled NO in pulmonary vessels. As the main clinical effects, both improved oxygenation and a drop of pulmonary artery pressure despite unchanged arterial pressure were observed. Since then, many studies have evaluated the effects of inhaled NO as well as of other aerosolised vasodilators (e.g. PGI(2), PGE(1), nitrates, phosphodiesterase-inhibitors) in patients with pulmonary hypertension, acute right heart failure and/or life-threatening hypoxemia. However, primary pulmonary hypertension of the newborn (PPHN) is the only indication for which inhaled NO has been clinically approved so far. Although an obvious clinical benefit in outcome from inhaled vasodilators has never been formally documented, good clinical efficacy has resulted in an increasing "off label" use of the concept both in Germany and worldwide, particularly with respect to anaesthesia and intensive care medicine. The present article aims to review both the pathophysiological and pharmacological basis of inhaled vasodilators, to critically reevaluate their potential clinical indications and to give a perspective on future developments in the field.

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Inhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery

Cited by 70 publications

References 27 publications

Inhaled Nitric Oxide in Patients With Pulmonary Hypertension Due to Valvular Heart Disease and Chronic Lung Disease

Inhaled Nitric Oxide in Patients With Pulmonary Hypertension Due to Valvular Heart Disease and Chronic Lung Disease

Searching the Ideal Inhaled Vasodilator: From Nitric Oxide to Prostacyclin

Inhalierte Vasodilatatoren

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