Rebound pulmonary hypertension on withdrawal from inhaled nitric oxide

Miller, Owen; Tang, Swee Fong; Keech, Anthony; Celermajer, D.

doi:10.1016/s0140-6736(95)92681-x

Cited by 182 publications

(97 citation statements)

References 4 publications

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“…3,4 Moreover, an interruption in the inhalation of continuous nitric oxide may cause rebound pulmonary hypertension. 5,6 Designed to combine the beneficial effects of prostacyclin with those of an inhalational application, aerosolized prostacyclin was found to be a potent pulmonary vasodilator in patients with acute respiratory failure, exerting preferential vasodilatation in well-ventilated lung regions. [7][8][9][10] Similar results were obtained in spontaneously breathing patients who had lung fibrosis and severe pulmonary hypertension.…”

Section: Resultsmentioning

confidence: 99%

Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

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Section: Resultsmentioning

confidence: 99%

Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

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“…8 The nebulization of PGI 2 or iloprost might have some advantages over the inhalation of NO, such as its lack of toxic reactions 23,24 (which require monitoring NO 2 and methemoglobin formation during NO inhalation) and its easy administration by conventional nebulizers compared with the more complicated delivery systems required for NO. Furthermore, possibly life-threatening rebound phenomenons have been described with iNO 25,26 but not with aerosolized PGI 2 or iloprost withdrawal. These advantages might favor the use of iloprost for the treatment of PHT; however, because of the lack of well-documented studies with prostacyclin or prostacyclin analogs, it might be too early to recommend the use of iloprost instead of iNO for the postoperative management of patients with PHT and CHD.…”

Section: Discussionmentioning

confidence: 99%

Inhaled Nitric Oxide Versus Aerosolized Iloprost in Secondary Pulmonary Hypertension in Children With Congenital Heart Disease

Rimensberger

Spahr-Schopfer²,

Berner³

et al. 2001

Circulation

170

116

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Background-Inhaled nitric oxide (iNO) has been used to assess the vasodilator capacity of the pulmonary vascular bed in children with congenital heart disease and elevated pulmonary vascular resistance. Inhaled iloprost is a pulmonary vasodilator for the long-term treatment of pulmonary hypertension (PHT). Because these 2 vasodilators act through different pathways (release of cGMP or cAMP, respectively), we compared the pulmonary vasodilator capacity of each. Methods and Results-A total of 15 children with congenital heart disease and PHT who had elevated pulmonary vascular resistance (preoperative, nϭ10; immediately postoperative, nϭ5) were first given 20 ppm of iNO for 10 minutes; then, after baseline values were reached again, they were given aerosolized iloprost at 25 ng ⅐ kg Ϫ1 ⅐ min Ϫ1 for another 10 minutes. Finally, iNO and iloprost were given simultaneously for 10 minutes. With iNO, the pulmonary vascular resistance and systemic vascular resistance ratio decreased from 0.48Ϯ0.38 to 0.27Ϯ0.16 (PϽ0.001). Similarly, iloprost decreased the ratio from 0.49Ϯ0.38 to 0.26Ϯ0.11 (PϽ0.05). The combination had no additional effect on the resistance ratio. Plasma cGMP increased from 17.6Ϯ11.9 to 34.7Ϯ21.4 nmol/L during iNO (PϽ0.01), and plasma cAMP increased from 55.7Ϯ22.9 to 65.1Ϯ21.2 nmol/L during iloprost inhalation (PϽ0.05). Conclusions-In children with PHT and congenital heart disease, both iNO and aerosolized iloprost are equally effective in selectively lowering pulmonary vascular resistance through an increase in cGMP or cAMP, respectively. However, the combination of both vasodilators failed to prove more potent than either substance alone. Aerosolized iloprost might be an alternative to iNO for early testing of vascular reactivity and for the postoperative treatment of acute PHT.

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“…9 Because of its short half-life, NO has to be administered continuously, and even brief interruptions may cause a dangerous rebound of PH. 10 The advantages of inhaled PGI 2 and iloprost include a lack of toxic reactions and ease of administration. 7,11 On the other hand, Haraldsson et al found no improved effects on hemodynamic variables, comparing inhaled PGI 2 with inhaled NO in the evaluation of heart transplant candidates.…”

Section: Objectifmentioning

confidence: 99%

Selective pulmonary vasodilation with inhaled aerosolized milrinone in heart transplant candidates

Sablotzki¹,

Starzmann²,

Scheubel

et al. 2005

Can J Anesth/J Can Anesth

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Purpose: Selective pulmonary vasodilation is an advantageous method for testing the responsiveness of the pulmonary vasculature of heart transplant candidates. A pilot study was undertaken to test the hypothesis that inhaled aerosolized milrinone may cause selective pulmonary vasodilation.Methods: 18 consecutive male heart transplant candidates with either dilated or ischemic cardiomyopathy were included in this open clinical study. Nine of the patients had significant pulmonary hypertension with a mean pulmonary arterial pressure > 30 mmHg. After baseline measurements, 2 mg of milrinone was administered by ultrasonic nebulization. Pulmonary and systemic hemodynamics were measured ten, 30, and 60 min after inhalation. Results:After inhalation for ten minutes, milrinone induced a significant reduction of mean pulmonary arterial pressure (32.7 ± 9.1 vs 37.7 ± 7.5 mmHg, P = 0.01), pulmonary vascular resistance index (296 ± 150 vs 396 ± 151 dyn·sec -1 ·cm -5 · · m 2 , P = 0.02) and transpulmonary gradient (10.6 ± 5.5 vs 15 ± 4.9, P = 0.01) only in patients with significant pulmonary hypertension. There was no significant effect on mean arterial pressure or systemic vascular resistance at any time after inhalation in either group. Furthermore, there was no influence on extravascular lung water or intrathoracic blood volume. Conclusions:We conclude that inhaled aerosolized milrinone for a short period selectively dilates the pulmonary vasculature in heart transplant candidates with elevated pulmonary arterial pressure, without producing systemic side effects. Further comparative studies are necessary to evaluate possible advantages of milrinone compared to other inhaled vasodilators. Résultats : Après avoir été inhalée pendant 10 min, la milrinone a réduit significativement la tension artérielle pulmonaire moyenne (32,7 ± 9,1 vs 37,7 ± 7,5 mmHg, P = 0,01), l'index de résistance vasculaire pulmonaire (296 ± 15 vs 396 ± 151 dyn·s -1 ·cm -5 ·m 2 , P = 0,02) et le gradient transpulmonaire (10,6 ± 5,5 vs 15 ± 4,9, P = 0,01) Objectif

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Rebound pulmonary hypertension on withdrawal from inhaled nitric oxide

Cited by 182 publications

References 4 publications

Inhaled Iloprost for Severe Pulmonary Hypertension

Inhaled Iloprost for Severe Pulmonary Hypertension

Inhaled Nitric Oxide Versus Aerosolized Iloprost in Secondary Pulmonary Hypertension in Children With Congenital Heart Disease

Selective pulmonary vasodilation with inhaled aerosolized milrinone in heart transplant candidates

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