LARGE INCREASE IN CARDIAC-OUTPUT IN A PATIENT WITH ARDS AND ACUTE RIGHT HEART-FAILURE DURING INHALATION OF NITRIC-OXIDE

Background: Inhaled nitric oxide (NO), a selective pulmonary vasodilat or, reduces pulmonary artery pressure in patients with acute respirato ry distress syndrome (ARDS). In spite of the reduction of right ventri cular afterload, the effect of NO on cardiac output remains unclear. M ethods: A patient with ARDS and echocardiographically determined sever e acute right heart failure was treated with increasing concentrations of inhaled nitric oxide (NO). Haemodynamic and gas exchange variables were determined for each concentration of NO. NO treatment was contin ued for 3 days. Results: During initial right heart failure, administr ation of NO resulted in a large increase (32%) in cardiac output in a dose-dependent manner. When right ventricular function had improved, i nhalation of NO did not increase cardiac output. Conclusion: Our obser vations suggest that inhalation of NO is likely to increase cardiac ou tput in ARDS when severe acute right heart failure is present. (C) Act a Anaesthesiologica Scandinavica 41 (1997).