Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis.
A patient with severe interstitial pulmonary fibrosis, hypoxemia, pulmonary hypertension, and cor pulmonale was given inhaled nitric oxide (NO) followed by intravenous PGE1 to assess the reversibility of pulmonary hypertension. During NO inhalation, there was marked reduction in pulmonary vascular resistance, increased cardiac output, and dramatic improvement in arterial oxygenation. There was no effect on systemic vascular resistance. In contrast, intravenous PGE1 led to rapid arterial oxygen desaturation and worsened dyspnea. The beneficial responses to inhaled NO in this patient suggest that, even in severe chronic lung disease, reversible pulmonary vasoconstriction is present. Inhaled NO thus has a potential therapeutic role as a selective pulmonary vasodilator in patients with interstitial pulmonary fibrosis and cor pulmonale.
Channick
R N
RN
Pulmonary and Critical Care Division, University of California, San Diego Medical Center 92103.
Hoch
R C
RC
Newhart
J W
JW
Johnson
F W
FW
Smith
C M
CM
D000280:Administration, Inhalation; D000328:Adult; D000527:Alprostadil / Q000494:pharmacology / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000860:Hypoxia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D009569:Nitric Oxide / Q000494:pharmacology / Q000627:therapeutic use*; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D014057:Tomography, X-Ray Computed
D009569:Nitric Oxide; D000527:Alprostadil