The effects of inhaled nitric oxide on postoperative pulmonary hypertension in infants and children undergoing surgical repair of congenital heart disease

被引:55
作者
Russell, IAM
Zwass, MS
Fineman, JR
Balea, M
Rouine-Rapp, K
Brook, M
Hanley, FL
Silverman, NH
Cahalan, MK
机构
[1] Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Pediat, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Dept Surg, San Francisco, CA 94143 USA
关键词
D O I
10.1097/00000539-199807000-00011
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
The role of inhaled nitric oxide in the immediate postbypass period after surgical repair of congenital heart disease is uncertain. In a controlled, randomized, double-blind study, we tested the hypothesis that inhaled nitric oxide (NO) would reduce pulmonary hypertension immediately after surgical repair of congenital heart disease in 40 patients with preoperative evidence of pulmonary hypertension (mean pulmonary arterial pressure [MPAP] exceeding 50% of mean systemic arterial pressure [MSAP]). Patients were then followed in the intensive care unit (ICU) to document the incidence of severe pulmonary hypertension Of the patients, 36% (n = 13) emerged from bypass with MPAP >50% MSAP. In these patients, inhaled NO reduced MPAP by 19% (P = 0.008) versus an increase of 9% in the placebo group. No effect on MPAP was observed in patients emerging from bypass without pulmonary hypertension (n = 23). Inhaled NO was required five times in the ICU, always in the patients who had emerged from cardiopulmonary bypass with pulmonary hypertension (5 of 13 [38%] versus 0 of 23). We conclude that, in infants and children undergoing congenital heart surgery, inhaled NO selectively reduces MPAP in patients who emerge from cardiopulmonary bypass with pulmonary hypertension and has no effect on those who emerge without it. Implications: In a randomized double-blind study, inhaled nitric oxide selectively reduced pulmonary artery pressures in pediatric patients who developed pulmonary hypertension (high blood pressure in the lungs) immediately after cardiopulmonary bypass and surgical repair.
引用
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页码:46 / 51
页数:6
相关论文
共 10 条
[1]   INHALED NITRIC-OXIDE AFTER MITRAL-VALVE REPLACEMENT IN PATIENTS WITH CHRONIC PULMONARY-ARTERY HYPERTENSION [J].
GIRARD, C ;
LEHOT, JJ ;
PANNETIER, JC ;
FILLEY, S ;
FFRENCH, P ;
ESTANOVE, S .
ANESTHESIOLOGY, 1992, 77 (05) :880-883
[2]   REPAIR OF TRUNCUS ARTERIOSUS IN THE NEONATE [J].
HANLEY, FL ;
HEINEMANN, MK ;
JONAS, RA ;
MAYER, JE ;
COOK, NR ;
WESSEL, DL ;
CASTANEDA, AR .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1993, 105 (06) :1047-1056
[3]  
KINSELLA JP, 1969, J PEDIATR, V122, P803
[4]   INHALED NITRIC-OXIDE AS A CAUSE OF SELECTIVE PULMONARY VASODILATATION IN PULMONARY-HYPERTENSION [J].
PEPKEZABA, J ;
HIGENBOTTAM, TW ;
DINHXUAN, AT ;
STONE, D ;
WALLWORK, J .
LANCET, 1991, 338 (8776) :1173-1174
[5]   INHALED NITRIC-OXIDE - SELECTIVE PULMONARY VASODILATION IN CARDIAC SURGICAL PATIENTS [J].
RICH, GF ;
MURPHY, GD ;
ROOS, CM ;
JOHNS, RA .
ANESTHESIOLOGY, 1993, 78 (06) :1028-1035
[6]  
Roberts J D Jr, 1993, Crit Care Med, V21, pS374, DOI 10.1097/00003246-199309001-00047
[7]   INHALED NITRIC-OXIDE IN CONGENITAL HEART-DISEASE [J].
ROBERTS, JD ;
LANG, P ;
BIGATELLO, LM ;
VLAHAKES, GJ ;
ZAPOL, WM .
CIRCULATION, 1993, 87 (02) :447-453
[8]   INHALED NITRIC-OXIDE FOR THE ADULT RESPIRATORY-DISTRESS SYNDROME [J].
ROSSAINT, R ;
FALKE, KJ ;
LOPEZ, F ;
SLAMA, K ;
PISON, U ;
ZAPOL, WM .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 328 (06) :399-405
[9]  
Wessel D L, 1993, Crit Care Med, V21, pS344, DOI 10.1097/00003246-199309001-00024
[10]   USE OF INHALED NITRIC-OXIDE AND ACETYLCHOLINE IN THE EVALUATION OF PULMONARY-HYPERTENSION AND ENDOTHELIAL FUNCTION AFTER CARDIOPULMONARY BYPASS [J].
WESSEL, DL ;
ADATIA, I ;
GIGLIA, TM ;
THOMPSON, JE ;
KULIK, TJ .
CIRCULATION, 1993, 88 (05) :2128-2138