H. Imanaka et al., Effects of nitric oxide inhalation after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, CHEST, 118(1), 2000, pp. 39-46
Citations number
24
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Study objectives: To examine the hypothesis that nitric oxide (NO) inhalati
on improves hemodynamics and gas exchange In patients with chronic pulmonar
y 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 e
lective pulmonary thromboendarterectomy) for chronic pulmonary thromboembol
ism.
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 a
nalyzed before, during, and after NO inhalation, Waveform of pulmonary arte
ry pressure (PAP) was evaluated using fractional pulse pressure (PPD: (syst
olic PAP - diastolic PAP)/mean PAP. After surgery, pulmonary vascular resis
tance decreased, PPf decreased, and cardiac index increased significantly.
At the first trial, NO inhalation resulted in a slight improvement in arter
ial oxygen tension (from 173 +/- 33 to 196 +/- 44 mm Hg; p < 0.05), while h
emodynamics 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 n
ot significant.
Conclusions: Immediately after pulmonary thromboendarterectomy for chronic
pulmonary thromboembolism, NO inhalation improved oxygenation; at 12 h afte
r surgery, NO inhalation resulted in decreased pulmonary vascular resistanc
e, although both changes were small.