Nitric oxide delivery during cardiopulmonary bypass reduces acute kidney injury: A randomized trial

Каменщиков, Н. О.; Anfinogenova, Yana; Козлов, Б. Н.; Svirko, Yulia S.; Pekarskiy, S.; Евтушенко, В В; Lugovsky, Vladimir A.; Шипулин, В. М.; Ломиворотов, В. В.; Podoksenov, Yuriy K.

doi:10.1016/j.jtcvs.2020.03.182

Cited by 37 publications

(36 citation statements)

References 52 publications

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“…A significant limitation to the widespread administration of iNO therapy could be the fear of an increased risk of acute kidney injury seen in patients with non-COVID ARDS [151], but our data does not confirm this, and in fact, refutes this notion [152]. Taking into consideration the uniqueness of the pathogenesis of organ complications in COVID-19, the data obtained may indicate the possibility of context-sensitive use of iNO in various clinical scenarios, in particular, to reduce microvascular damage and microcirculatory thrombosis, leading to systemic manifestations of infection and organ dysfunction [75].…”

Section: Special Consideration Of Safety Ino In Covid-19contrasting

confidence: 83%

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

Каменщиков

Carroll

2022

Biomedicines

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The global COVID-19 pandemic has become the largest public health challenge of recent years. The incidence of COVID-19-related acute hypoxemic respiratory failure (AHRF) occurs in up to 15% of hospitalized patients. Antiviral drugs currently available to clinicians have little to no effect on mortality, length of in-hospital stay, the need for mechanical ventilation, or long-term effects. Inhaled nitric oxide (iNO) administration is a promising new non-standard approach to directly treat viral burden while enhancing oxygenation. Along with its putative antiviral affect in COVID-19 patients, iNO can reduce inflammatory cell-mediated lung injury by inhibiting neutrophil activation, lowering pulmonary vascular resistance and decreasing edema in the alveolar spaces, collectively enhancing ventilation/perfusion matching. This narrative review article presents recent literature on the iNO therapy use for COVID-19 patients. The authors suggest that early administration of the iNO therapy may be a safe and promising approach for the treatment of COVID-19 patients. The authors also discuss unconventional approaches to treatment, continuous versus intermittent high-dose iNO therapy, timing of initiation of therapy (early versus late), and novel delivery systems. Future laboratory and clinical research is required to define the role of iNO as an adjunct therapy against bacterial, viral, and fungal infections.

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Section: Special Consideration Of Safety Ino In Covid-19contrasting

confidence: 83%

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

Каменщиков

Carroll

2022

Biomedicines

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“…In regard to cardiac surgical patients at risk of developing AKI, studies show that the perioperative delivery of NO in cardiac surgical patients is safe. There is no significant increase in the inspiratory concentration of NO 2 , methemoglobin, hemodynamic disorders, cytokine changes or postoperative bleeding [ 245 ]. The first clinical work to study NO intervention at 80 ppm during and after CPB showed a decrease in AKI incidence and an improved 1-year kidney outcome in cardiac surgery patients [ 246 ].…”

Section: The Role Of Nitric Oxide In Preventing Cardiac Surgery-assoc...mentioning

confidence: 99%

“…The first clinical work to study NO intervention at 80 ppm during and after CPB showed a decrease in AKI incidence and an improved 1-year kidney outcome in cardiac surgery patients [ 246 ]. Another cardiac surgical cohort showed that 40 ppm of NO administration to the CPB circuit leads to a decrease in AKI incidence and AKI severity, as well as improved kidney function [ 245 ]. The same group of authors demonstrated the intraoperative disturbance of NO homeostasis, assessed based on NO metabolites, which leads to the formation of perioperative NO deficiency in control patients [ 245 ].…”

Section: The Role Of Nitric Oxide In Preventing Cardiac Surgery-assoc...mentioning

confidence: 99%

“…Another cardiac surgical cohort showed that 40 ppm of NO administration to the CPB circuit leads to a decrease in AKI incidence and AKI severity, as well as improved kidney function [ 245 ]. The same group of authors demonstrated the intraoperative disturbance of NO homeostasis, assessed based on NO metabolites, which leads to the formation of perioperative NO deficiency in control patients [ 245 ]. Furthermore, a meta-analysis confirmed that perioperative NO delivery is associated with a reduced risk of AKI in cardiac surgery [ 247 ].…”

Section: The Role Of Nitric Oxide In Preventing Cardiac Surgery-assoc...mentioning

confidence: 99%

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Nitric Oxide in Cardiac Surgery: A Review Article

Каменщиков

Duong

2023

Biomedicines

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Perioperative organ injury remains a medical, social and economic problem in cardiac surgery. Patients with postoperative organ dysfunction have increases in morbidity, length of stay, long-term mortality, treatment costs and rehabilitation time. Currently, there are no pharmaceutical technologies or non-pharmacological interventions that can mitigate the continuum of multiple organ dysfunction and improve the outcomes of cardiac surgery. It is essential to identify agents that trigger or mediate an organ-protective phenotype during cardiac surgery. The authors highlight nitric oxide (NO) ability to act as an agent for perioperative protection of organs and tissues, especially in the heart–kidney axis. NO has been delivered in clinical practice at an acceptable cost, and the side effects of its use are known, predictable, reversible and relatively rare. This review presents basic data, physiological research and literature on the clinical application of NO in cardiac surgery. Results support the use of NO as a safe and promising approach in perioperative patient management. Further clinical research is required to define the role of NO as an adjunct therapy that can improve outcomes in cardiac surgery. Clinicians also have to identify cohorts of responders for perioperative NO therapy and the optimal modes for this technology.

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“…В России исследование влияния подаваемого в контур ИК NO в клинических условиях на эффективность предупреждения развития ОПП проведено специалистами из Томска [23]. В проспективное РКИ было включено 96 пациентов с умеренным риском почечных осложнений, перенесших плановую кардиохирургическую операцию с применением ИК.…”

Section: системные и органные эффекты доставляемого в контур циркуляц...unclassified

Delivery of Gaseous Nitric Oxide to the Extracorporeal Circulation Circuit: Experimental and Clinical Data: a review

Пичугин

Баутин

Domnin³

et al. 2021

Annals of Critical Care

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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.

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Nitric oxide delivery during cardiopulmonary bypass reduces acute kidney injury: A randomized trial

Cited by 37 publications

References 52 publications

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

Nitric Oxide in Cardiac Surgery: A Review Article

Delivery of Gaseous Nitric Oxide to the Extracorporeal Circulation Circuit: Experimental and Clinical Data: a review

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