title: Additive effect on gas exchange of inhaled nitric oxide and intravenous almitrine bismesylate in the adult respiratory distress syndrome.
abstract: OBJECTIVE
  To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange.
  
  
  METHODS
  Prospective self-controlled study.
  
  
  METHODS
  3 medico-surgical intensive care units.
  
  
  METHODS
  17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88 +/- 30 mmHg, venous admixture: 47 +/- 7%) and elevated mean pulmonary artery pressure (MPAP: 30 +/- 5 mmHg) due to adult respiratory distress syndrome (ARDS).
  
  
  METHODS
  5 conditions were studied: 1) baseline, 2) 5 to 10 ppm of NO during 30 min, 3) discontinuation of NO during 30 min, 4) ALM infusion (0.5 mg/kg) during 30 min, 5) ALM infusion (0.5 mg/kg) during 30 min in combination with 5 to 10 ppm of NO.
  
  
  RESULTS
  The PaO2/FIO2 ratio rose from 88 +/- 30 to 98 +/- 37 mmHg (NS) with NO alone, and from 92 +/- 25 to 130 +/- 56 mmHg (p < 0.01) with NO + ALM (p < 0.05 vs NO alone). Seven patients were considered as "NO-responders" (rise in PaO2/FIO2 ratio of 10 mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87 +/- 30 to 128 +/- 39 mmHg (p < 0.05) with NO alone, and from 93 +/- 20 to 169 +/- 51 mmHg (p < 0.01) with NO + ALM (p < 0.05 versus NO alone). MPAP decreased from 30 +/- 5 to 26 +/- 5 mmHg (p < 0.01) with NO alone, increased slightly from 28 +/- 5 to 31 +/- 5 mmHg (NS) with ALM alone and decreased to 27 +/- 5 mmHg (p < 0.05) with NO + ALM.
  
  
  CONCLUSIONS
  NO + ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.
authors.affiliation: Service de Réanimation Polyvalente, Hôpital International de l'Université de Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Wysocki
authors.forename: C
authors.initials: C
authors.lastname: Delclaux
authors.forename: E
authors.initials: E
authors.lastname: Roupie
authors.forename: O
authors.initials: O
authors.lastname: Langeron
authors.forename: N
authors.initials: N
authors.lastname: Liu
authors.forename: B
authors.initials: B
authors.lastname: Herman
authors.forename: F
authors.initials: F
authors.lastname: Lemaire
authors.forename: L
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D015765:Almitrine / Q000008:administration & dosage*; D000704:Analysis of Variance; D004357:Drug Synergism; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D009569:Nitric Oxide; D015765:Almitrine