Efficacy and safety of inhaled nitric oxide in patients with acute pulmonary hypertension due to exacerbation of chronic obstructive pulmonary disease (COPD)
Abstract
The study objective was to assess effects of inhaled nitric oxide (iNO) on pulmonary hemodynamics and gas exchange in patients with acute cor pulmonale due to acute exacerbation of COPD and to evaluate an optimal dose and factors predicting the response to iNO in these patients.
Fifteen patients (3 females, 12 males; mean age of 58.0 ± 6.4 yrs; FEV1 0.88 ± 0.24 L; PaO2 52.6 ± 3.5 mm Hg; PaCO2 49.4 ± 8.2 mm Hg) with acute exacerbation of COPD, not requiring respiratory support were involved to the study.
Oxygenation and haemodynamic variables were measured initially against the supplemental oxygen back ground and then 15 min after each sequential addition of 10, 20, and 30 ppm iNO to the gas mixture. The patients were considered as responders if the mean pulmonary artery pressure (Ppa) or the pulmonary vascular resistance (PVR) decreased by 20 % . An electrochemical gas sensor device PrinterNOx provided continuous analysis of nitric oxide and oxidative nitric oxide products.
There was an improvement in haemodynamic variables during the iNO inhalations: Poa decreased from 36 ± 6 to 28 ± 3 mm Hg, PVR decreased from 371 ± 83 to 249 ± 49 dyne sec/cm-5 (all p < 0.01), the cardiac index did not change. There was a mild but significant improvement in oxygenation at 10 ppm iNO ( P a 0 2 increased from 64 ± 6 to 6 8 ± 9 mm Hg, p < 0.01, and Qs/Qt reduced from 23 ± 5 to 20 ± 4 % , p < 0.05), Pa C 0 2 remained unchanged. Twelve patients (80 % ) responded to iNO. The ¡NO-induced decrease in Ppa and PVR correlated positively with the basal Ppa and PVR (all p< 0 .01 ) and negatively with the basal pH (all p < 0.05).
Conclusion. Our data show that iNO improves the pulmonary hemodynamics and oxygenation in patients with acute exacerbation of COPD and that the optimal iNO dose for the treatment of both pulmonary hyper tension and hypoxemia was 10 ppm. The response to iNO was greater in patients with more severe pulmonary hypertension and respiratory acidosis.
About the Authors
S. N. Avdeev
НИИ пульмонологии Минздрава РФ
Russian Federation
Russian Federation
N. A. Tsareva
НИИ пульмонологии Минздрава РФ
Russian Federation
Russian Federation
G. V. Nekludova
НИИ пульмонологии Минздрава РФ
Russian Federation
Russian Federation
A. G. Chuchalin
НИИ пульмонологии Минздрава РФ
Russian Federation
Russian Federation
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Review
For citations:
Avdeev S.N., Tsareva N.A., Nekludova G.V., Chuchalin A.G. Efficacy and safety of inhaled nitric oxide in patients with acute pulmonary hypertension due to exacerbation of chronic obstructive pulmonary disease (COPD). PULMONOLOGIYA. 2004;(2):89-96. (In Russ.)
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