The use of phosphodiesterase inhibitor (dipyridamole) to wean from inhaled nitric oxide.
A full-term, male neonate developed persistent pulmonary hypertension, and responded to high-frequency oscillatory ventilation and inhaled nitric oxide (INO). Discontinuation of INO was attempted three times and was followed by severe desaturations due to right-to-left shunt through the patent ductus arteriosus and patent foramen ovale. As a result of this rebound pulmonary hypertension, the neonate was maintained on INO therapy for 6 days. Successful discontinuation was achieved by using the phosphodiesterase inhibitor, dipyridamole. We speculate that during exogenous INO therapy, endogenous nitric oxide was inhibited, thus cyclic guanosine 3',5'-monophophate, the smooth muscle relaxant, was rapidly hydrolyzed. By inhibiting phosphodiesterase, smooth muscle relaxation occurred, and consequently weaning from INO was achieved.
al-Alaiyan
S
S
Department of Pediatrics (MBC 58), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
al-Omran
A
A
Dyer
D
D
D000280:Administration, Inhalation; D001784:Blood Gas Analysis; D004176:Dipyridamole / Q000627:therapeutic use*; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000009:adverse effects*; D010547:Persistent Fetal Circulation Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D010726:Phosphodiesterase Inhibitors; D009569:Nitric Oxide; D004176:Dipyridamole