A. Lavoie et al., LIFE-THREATENING EFFECTS OF DISCONTINUING INHALED NITRIC-OXIDE IN SEVERE RESPIRATORY-FAILURE, American journal of respiratory and critical care medicine, 153(6), 1996, pp. 1985-1987
Citations number
13
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
We present the effects of abrupt discontinuation of inhaled nitric oxi
de (NO) in four patients with severe hypoxemic: respiratory failure. T
hese patients ranged from 9 mo to 65 yr of age. In each patient, after
the initiation of inhaled NO, a marginal, but immediate, beneficial e
ffect on gas exchange and, when measured, a reduction in pulmonary art
ery pressures was noted. However, during attempts to discontinue inhal
ed NO, not only did these patients develop worsening oxygenation and r
ecrudescence of pulmonary hypertension but, unexpectedly, these parame
ters were worse than the baseline values, leading to life-threatening
hemodynamic instability. These effects reversed immediately after rein
stitution of inhaled NO. The mechanism of this severe ''rebound'' in p
ulmonary hypertension after abrupt withdrawal of NO is unclear, but it
s existence emphasizes the need to avoid a substantial risk to these p
atients. Moreover, we believe that both unintentional and intentional
termination of inhaled NO therapy may lead to life-threatening deterio
ration in gas exchange and circulatory hemodynamics that exceeds the i
nitial therapeutic benefit.