Document Detail


Effect of inhaled nitric oxide on gas exchange in patients with congestive heart failure. A randomized, controlled trial.
MedLine Citation:
PMID:  9890849     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Conventional vasodilators increase ventilation-perfusion mismatch and do not improve gas exchange even though they reduce pulmonary hypertension. However, the effects of nitric oxide inhalation on ventilatory and gas exchange values in patients with congestive heart failure are not known. OBJECTIVE: To investigate the effect of nitric oxide inhalation on gas exchange in patients with congestive heart failure. DESIGN: Randomized, controlled trial. SETTING: University hospital. PATIENTS: 16 patients with congestive heart failure (New York Heart Association class II or III). INTERVENTIONS: Patients inhaled nitric oxide gas at graded concentrations (n = 8) or were given intravenous isosorbide dinitrate, 2.5 mg (n = 8). MEASUREMENTS: Hemodynamic and ventilatory variables and blood gases were measured 5 minutes after inhalation of different doses of nitric oxide and 10 minutes after administration of isosorbide dinitrate. RESULTS: Nitric oxide inhalation reduced the mean pulmonary arterial pressure in a dose-dependent manner without altering the mean arterial pressure or cardiac output. At a dose of 40 parts per million, nitric oxide inhalation increased PaO2 (change from baseline, 12.0 mm Hg [95% CI, 2.3 to 21.7 mm Hg]; P = 0.014) and decreased the alveolar-arterial difference in partial pressure of oxygen (change, -8.6 mm Hg [CI, -16.8 to -0.4 mm Hg]; P = 0.038) and the ventilatory equivalent for carbon dioxide output (change, -6.7 [CI, -10.3 to -3.1]; P < 0.001). Although isosorbide dinitrate similarly decreased pulmonary arterial pressure, it did not alter gas exchange or ventilatory variables. CONCLUSIONS: Because nitric oxide inhalation improved gas exchange, it may be used as a supportive therapy when other conventional vasodilators worsen gas exchange.
Authors:
A Matsumoto; S Momomura; S Sugiura; H Fujita; T Aoyagi; M Sata; M Omata; Y Hirata
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  130     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-01-08     Completed Date:  1999-01-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  40-4     Citation Subset:  AIM; IM    
Affiliation:
University of Tokyo, Japan. amatsu-tky@umin.u-tokyo.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adult
Aged
Carbon Dioxide / blood
Dose-Response Relationship, Drug
Female
Heart Failure / blood,  physiopathology*
Hemodynamics / drug effects
Humans
Injections, Intravenous
Isosorbide Dinitrate / administration & dosage
Male
Middle Aged
Nitric Oxide / administration & dosage*
Oxygen / blood
Pulmonary Gas Exchange / drug effects*
Vasodilator Agents / administration & dosage*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen; 87-33-2/Isosorbide Dinitrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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