Document Detail


Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery.
MedLine Citation:
PMID:  10074645     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decrease blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 +/- 2.0 to 26.0 +/- 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 +/- 3.1 to 75.9 +/- 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.
Authors:
J R Beck; L B Mongero; R M Kroslowitz; A F Choudhri; J M Chen; J J DeRose; M Argenziano; A J Smerling; M C Oz
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Perfusion     Volume:  14     ISSN:  0267-6591     ISO Abbreviation:  Perfusion     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-05-04     Completed Date:  1999-05-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  37-42     Citation Subset:  IM    
Affiliation:
Department of Surgery, Columbia Presbyterian Medical Center, New York, NY, USA. beckjam@cpmc3.cis.columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Administration, Inhalation
Blood Pressure / drug effects
Cardiac Surgical Procedures*
Female
Hemodynamics / drug effects*
Humans
Hypertension, Pulmonary / drug therapy*,  etiology*,  physiopathology
Male
Middle Aged
Nitric Oxide / administration & dosage*,  therapeutic use
Postoperative Complications*
Pulmonary Artery / physiopathology
Risk Factors
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide

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


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