Inhaled nitric oxide in primary pulmonary hypertension: effects on pulmonary haemodynamics, gas exchange and oxygen transport
Abstract
The study assess effects of inhaled nitric oxide on pulmonary haemodynamics, gas exchange and oxygen transport in patients with primary pulmonary hypertension (PPH) and evaluates factors predicting the response to inhaled nitric oxide.
Ten patients with PPH (8 females, 2 males) were observed.
Oxygenation and haemodynamic variables were measures and calculated at room air and then 15 min after each sequential addition of 10, 20 and 40 ppm nitric oxide to the gas mixture. Patients were considered responders if the mean pulmonary artery pressure or pulmonary vascular resistance decreased by 20%. An electrochemical gas sensor device PrinterNOx provided continuous analysis of nitric oxide and oxidative nitric oxide products.
There was a dose-dependent improvement in haemodynamic variables that was maximal at 40 ppm nitric oxide (mean pulmonary artery pressure decreased from 67±7 to 56±5 mm Hg, pulmonary vascular resistance index decreased from 1335±302 to 790±102 dyne sec/cm-5, and cardiac index increased from 2.3 to 2.7 L/min/m2, all p<0.05). There was a significant improvement in oxygen transport at 20 and 40 ppm nitric oxide (DO2 improved from 684±108 to 791±110 and 835±98, respectively, p<0.05). Five patients (50%) responded to NO. The responders differed from non-responders in such factors as distance during 6-minute walking test, pa02 and paC02 (all p≤0.01).
Our data show an improvement in pulmonary haemodynamics and oxygen transport in patients with primary pulmonary hypertension.
About the Authors
S. N. Avdeev
НИИ пульмонологии М3
Russian Federation
Russian Federation
N. A. Tsareva
НИИ пульмонологии М3
Russian Federation
Russian Federation
G. V. Nekludova
НИИ пульмонологии М3
Russian Federation
Russian Federation
I. E. Chazova
НИИ кардиологии им. А.Л. Мясникова РКНПК М3
Russian Federation
Russian Federation
A. G. Chuchalin
НИИ пульмонологии М3
Russian Federation
Russian Federation
References
1. Rabin L.J. АССР Consensus Statement: primiry pulmonary hypertension. Chest 1993; 104: 236—250.
2. Brij S., Peacock A.J. Pulmonary hypertension: its assessment and treatment. Thorax 1999; 54 (suppl.2): S28—S32.
3. Groechenig E. Cor pulmonale. Treatment of pulmonary hypertension. Blackwell Science, Berlin—Vienna, 1999; pp 146.
4. Чазова И.Е. Современные подходы к лечению легочного сердца. Рус. мед. журн. 2000; 8 (2): 83—86.
5. Rich S., Dantzker D.R., Agrès S.M. Primary pulmonary hypertension: a national prospective study. Ann. Intern. Med. 1987; 107: 216—223.
6. Pepke-Zaba I., Higgenbottam T.W., Dinnh-Xuan A.T. et al. Inhaied nitric oxide as a cause of sélective pulmonary vasodilatation in pulmonary hypertension. Lancet 1991; 338: 1173—1174.
7. Чучалин A .Г., Авдеев С.М., Царева И.А., Неклюдова Г.В., Науменко Ж.К., Черняев A.JI. Применение ингаляции оксида азота при первичной легочной гипертензии. Рус. мед. журн. 2001: 9 (1): 35—37.
8. Sitbon О., Humbert М ., Jagot J. et at. Inhaled nitric oxide as a screening agent for safely identifying responders to oral calciumchannel blockers in primary pulmonary hypertension. Eur. Respir. J. 1998; 12: 265—270.
9. Channick R.N., Newhart J.W., Johnson F.W. el al. Pulsed delivery of inhaled nitric oxide to patients with primary pulmonary hypertension. An ambulatory delivery system and initial clinical tests. Chest 1996; 109: 1545—1549.
10. Weir E.K., Rubin L.J., Ayres S.M. et al. The acute administration of vasodilators in primary pulmonary hypertension. Am. Rev. Respi. Dis. 1989; 140: 1623—1630.
11. Quanjer Ph.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Eur. Respir. J. 1993; 6 (suppl.l6): 5—40.
12. Cotes J.E., Chinn D.J., Quanjer Ph.H. et al. Standartization of the measurement of transfer factor (diffusing capacity). Eur. Respir. J. 1993; 6 (suppl. 16): 41—52.
13. Kitabatake A., I noue М., Asao M. et al. Noninvasive evaluation of pulmonary hypertension by a pulsed doppler technique. Circulation 1983; 68: 302—309.
14. Berger М., Haimovitz A., Van Tosh A. et al. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J. Am. Coll. Cardiol. 1985; 6: 359—365.
15. Kirshir iS., Himelman R.B., Schiller М.В . Right atrial pressure estimation in respiratory behavior of the inferior vena cava. Circulation 1988; 78: II—550 (2196).
16. Enright P.L., Sherill D.L. Reference equations for the six-minute walk in healthy adults. Am. J. Respir. Crit. Care Med. 1998; 158: 1384—1387.
17. Palmer R.M., Ferridge A.G., Moncada S. Nitric oxide accounts for the biological activity of endothelium derived relaxing factor. Nature. 1987; 327: 524—526.
18. Ignarro L.J., Buga G.M., Wood K.S. et al. Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proc. Natl. Acad. Sci. USA 1987; 84: 9265—9269.
19. Ignarro L.J. Biological actions and properties of endothelium-derived nitric oxide formed and released from artery and vein. Circ. Res. 1989; 65: 1—21
20. Siddons T.E., Asif М., Higenbottam T.W. Therapeutic role of nitric oxide in respiratory disease. Medscape 2000; 4 (2), Inc.
21. Jolliet P., Bulpa P., Thorens J.-B., Ritz M., Chevrolet J.-C. Nitric oxide and prostacyclin as test agents of vasoreactivity in severe precapillary pulmonary hypertension: predictive ability and consequences on haemodynamics and gas exchange. Thorax 1997; 52: 369—372
22. Loh E., Stamler J.S., Hare J.M. et al. Cardiovascular effects of inhaled nitric oxide in patients with left ventricular dysfunction. Circulation 1994; 90: 2780—2785.
23. Cockrill B.A., Kacmarek R.M., Fifer M.A. et al. Comparison of the effects of nitric oxide, nitroprusside, and nifedipine on hemodynamics and right ventricular contractility in patients with chronic pulmonary hypertension. Chest 2001; 119: 128—136.
24. Puybasset L., Rouby J.-J., Mourgeon E. et al. Factors influencing cardiopulmonary effects of inhaied nitric oxide in acute respiratory failure. Am. J. Respir. Crit. Care Med. 1995; 152: 318—328.
25. Hopkins S.R., Johnson E.C., Richardson R.S. et al. Effects of inhaled nitric oxide on gas exchange in lungs with shunt or poorly ventilated areas. Am. J. Respir. Crit. Care Med. 1997; 156: 484—491.
26. Koh E., Niimura J., Nakamura T. et al. Long-term inhalation of nitric oxide for a Datient with primary pulmonary hypertension. Jpn. Circ. J. 1998; 62: 940—942.
27. Perez-Penate G., Julia-Serda G., Pulido-Duque J.M. et al. One-year continuous inhaled nitric oxide for primary pulmonary hypertension. Chest 2001; 119: 970—973.
28. Gibbons G.H. Endothelial function as a determinant of vascular function and structure: A new therapeutic target. Am. J. Cardiol. 1997; 79: 3—8.
Review
For citations:
Avdeev S.N., Tsareva N.A., Nekludova G.V., Chazova I.E., Chuchalin A.G. Inhaled nitric oxide in primary pulmonary hypertension: effects on pulmonary haemodynamics, gas exchange and oxygen transport. PULMONOLOGIYA. 2001;(4):34-39. (In Russ.)
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