Effects of inhaled nitric oxide on right ventricular function in severe acute respiratory distress syndrome.
OBJECTIVE
To compare the effects of inhaled nitric oxide (NO) and an infusion of prostacyclin (PGI2) on right ventricular function in patients with severe acute respiratory distress syndrome (ARDS).


METHODS
Randomized prospective short-term study.


METHODS
Post-surgical ICU in an university hospital.


METHODS
10 patients with severe ARDS referred to our hospital for intensive care.


METHODS
In random sequence the patients inhaled NO at a concentration of 18 parts per million (ppm) followed by 36 ppm, and received an intravenous infusion of PGI2 (4 ng.kg-1.min-1).


RESULTS
Inhalation of 18 ppm NO reduced the mean (+/- SE) pulmonary artery pressure (PAP) from 33 +/- 2 to 28 +/- 1 mmHg (p = 0.008), increased right ventricular ejection fraction (RVEF), as assessed by thermodilution technique, from 28 +/- 2 to 32 +/- 2% (p = 0.005), decreased right ventricular end-diastolic volume index from 114 +/- 6 to 103 +/- 8 ml.m-2 (p = 0.005) and right ventricular end-systolic volume index from 82 +/- 4 to 70 +/- 5 ml.m-2 (p = 0.009). Mean arterial pressure (MAP) and cardiac index (CI) did not change significantly. The effects of 36 ppm NO were not different from the effects of 18 ppm NO. Infusion of PGI2 reduced PAP from 34 +/- 2 to 30 +/- 2 mmHg (p = 0.02), increased RVEF from 29 +/- 2 to 32 +/- 2% (p = 0.02). Right ventricular end-diastolic and end-systolic volume indices did not change significantly. MAP decreased from 80 +/- 4 to 70 +/- 5 mmHg (p = 0.03), and CI increased from 4.0 +/- 0.5 to 4.5 +/- 0.5 l.min-1.m-2 (p = 0.02).


CONCLUSIONS
Using a new approach to selective pulmonary vasodilation by inhalation of NO, we demonstrate in this group of ARDS patients that an increase in RVEF is not necessarily associated with a rise in CI. The increase in CI during PGI2 infusion is probably related to the systemic effect of this substance.
Rossaint
R
R
Klinik für Anaesthesiologie und Operative Intensivemedizin, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin, Germany.
Slama
K
K
Steudel
W
W
Gerlach
H
H
Pappert
D
D
Veit
S
S
Falke
K
K
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D002648:Child; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D009569:Nitric Oxide / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000187:drug effects*
D009569:Nitric Oxide; D011464:Epoprostenol