Effects of nitric oxide on hyperinflation-induced pulmonary hypertension in the isolated-perfused lung.
OBJECTIVE
To determine if nitric oxide decreases pulmonary vascular resistance in hyperinflation-induced pulmonary hypertension.


METHODS
Isolated-perfused lamb lung model.


METHODS
Experimental animal laboratory in a university setting.


METHODS
Ten isolated-perfused lamb lungs harvested from subjects with a mean age of 29 days.


METHODS
After induction of anesthesia, endotracheal intubation, and mechanical ventilation, lungs were perfused via an extracorporeal circuit. Ventilatory pressures were set to provide tidal volumes of 10 mL/kg and ventilatory rates were adjusted to maintain a Paco2 of 40 +/- 5 torr (3.5 +/- 0.7 kPa). The perfusion system consisted of a blood reservoir, a membrane oxygenator, and a nonocclusive roller pump. Blood flow was increased progressively to 50 mL/kg/min, maintaining a pulmonary arterial pressure of < 25 mm Hg and a left atrial pressure between 2 and 5 mm Hg. End-expiratory lung volume was measured using a nitrogen washout method. Baseline data were collected after a 1-hr stabilization period. Lung volume was increased to achieve 25% (moderate hyperinflation) and 50% (severe hyperinflation) increments in pulmonary vascular resistance. Nitric oxide (80 parts per million) was administered to the preparation after each increment in lung volume.


RESULTS
Mean pulmonary arterial pressure, mean left atrial pressure, pulmonary vascular resistance, and static lung compliance were measured at baseline and after moderate and severe hyperinflation, both before and after nitric oxide administration. Significant decreases in pulmonary vascular resistance were found when the preparation was ventilated with nitric oxide at baseline (43% decrease) and during hyperinflation induced pulmonary hypertension at both moderate (31% decrease) and severe (23% decrease) levels of hyperinflation.


CONCLUSIONS
Inhaled nitric oxide significantly reduces pulmonary vascular resistance, even when pulmonary hypertension is induced by airway hyperinflation and supraphysiologic lung volumes. These data suggest that the use of nitric oxide following lung transplantation may allow for effective management of pulmonary hypertension in patients who receive allografts from undersized donors. Further clinical experience will be crucial in precisely defining the range of donor-recipient size mismatch that can be adequately managed and the time course over which nitric oxide can be administered safely and effectively to these patients.
Ibla
J C
JC
Department of Surgery, Children's Hospital, Boston, MA 02115, USA.
Arnold
J H
JH
Thompson
J E
JE
Breuer
C K
CK
Benjamin
P K
PK
Lillehei
C W
CW
D000818:Animals; D006439:Hemodynamics / Q000187:drug effects; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008176:Lung Volume Measurements; D009569:Nitric Oxide / Q000494:pharmacology*; D011175:Positive-Pressure Respiration; D011652:Pulmonary Circulation / Q000187:drug effects; D012756:Sheep; D014655:Vascular Resistance / Q000187:drug effects*
D009569:Nitric Oxide