Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension

Introduction The use of low-dose dobutamine to maintain hemodynamic stabili ty in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO ), dobutamine and a combination of the two have beneficial effects in patie nts with end-stage airway lung disease and pulmonary hypertension. Method Hemodynamic evaluation was assessed 10 min after the administration of each drug and of their combination, in 28 candidates for lung transplant ation. Results Administration of INO caused a reduction in mean pulmonary arterial pressure (MPAP), an increase in PaO2 with a significant reduction in venou s admixture effect (Q(s)/Q(t)). Dobutamine administration caused an increas e in cardiac index and MPAP, with a decrease in PaO2 as a result of a highe r Q(s)/Q(t). Administration of a combination of the two drugs caused an inc rease in the cardiac index without MPAP modification and an increase in PaO 2 and Q(s)/Q(t). Conclusion Dobutamine and INO have complementary effects on pulmonary circu lation. Their association may be beneficial in the treatment of patients wi th mild to moderate pulmonary hypertension.