Effects of nitric oxide inhalation after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism.

Abstract

STUDY OBJECTIVES:

To examine the hypothesis that nitric oxide (NO) inhalation improves hemodynamics and gas exchange in patients with chronic pulmonary thromboembolism after pulmonary thromboendarterectomy.

DESIGN:

Prospective crossover clinical study.

SETTING:

: Surgical ICU in a national education and research hospital.

PATIENTS:

: Seven patients (mean age +/- SD, 54 +/- 11 years) who underwent elective pulmonary thromboendarterectomy for chronic pulmonary thromboembolism.

INTERVENTIONS:

Patients breathed 20 parts per million of NO gas for 30 min at 12-h intervals until extubation of the trachea.

MEASUREMENTS AND RESULTS:

Hemodynamics and arterial blood gas levels were analyzed before, during, and after NO inhalation. Waveform of pulmonary artery pressure (PAP) was evaluated using fractional pulse pressure (PPf): (systolic PAP - diastolic PAP)/mean PAP. After surgery, pulmonary vascular resistance decreased, PPf decreased, and cardiac index increased significantly. At the first trial, NO inhalation resulted in a slight improvement in arterial oxygen tension (from 173 +/- 33 to 196 +/- 44 mm Hg; p < 0.05), while hemodynamics did not change significantly. Twelve hours later, NO inhalation decreased pulmonary vascular resistance index (from 312 +/- 98 to 277 +/- 93 dyne.s. cm(-5)/m(2); p < 0.01), while the change in oxygenation was not significant.

CONCLUSIONS:

Immediately after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, NO inhalation improved oxygenation; at 12 h after surgery, NO inhalation resulted in decreased pulmonary vascular resistance, although both changes were small.

• Authors: H Imanaka, H Miyano, M Takeuchi, K Kumon, M Ando
• Journal: Chest (Chest) Vol. 118 Issue 1 Pg. 39-46 (Jul 2000) ISSN: 0012-3692 [Print] United States
• PMID: 10893357 (Publication Type: Journal Article)

Chemical References

• Vasodilator Agents
• Nitric Oxide
• Oxygen

Topics

• Aged
• Chronic Disease
• Endarterectomy
• Female
• Hemodynamics (drug effects)
• Humans
• Male
• Middle Aged
• Nitric Oxide (pharmacology)
• Oxygen (blood)
• Postoperative Period
• Prospective Studies
• Pulmonary Embolism (physiopathology, surgery)
• Pulmonary Gas Exchange (drug effects)
• Respiratory Mechanics (drug effects)
• Vascular Resistance (drug effects)
• Vasodilator Agents (pharmacology)