Efficacy of inhaled nitric oxide in oleic acid-induced acute lung injury.
OBJECTIVE
To assess the efficacy of inhaled nitric oxide in improving pulmonary hypertension and gas exchange following oleic acid-induced acute lung injury.


METHODS
Prospective, pharmacologic study.


METHODS
Surgical research laboratory at the University of Pittsburgh, Pittsburgh, PA.


METHODS
Instrumented, intubated pigs weighing 16 to 27 kg.


METHODS
Intravenous oleic acid and inhaled nitric oxide.


RESULTS
All pigs treated with intravenous oleic acid (0.11 mL/kg) developed a severe lung injury with pulmonary hypertension, accompanied by impaired oxygenation, intrapulmonary shunting, and increased extravascular lung water (p < .05 compared with baseline). Following nitric oxide inhalation, although pulmonary hypertension decreased in a dose-dependent fashion, no amelioration in pulmonary gas exchange was observed, as reflected by PaO2 and intrapulmonary shunt. Plasma nitrite and nitrate concentrations, the stable end products of nitric oxide metabolism, did not increase following nitric oxide exposure in this model of severe lung injury.


CONCLUSIONS
The effect of inhaled nitric oxide, restricted to relieving pulmonary vasoconstriction in this model of lung injury, may have limited benefit in improving pulmonary gas exchange when diffusion is impaired by severe lung injury and inflammatory thickening of the alveolar-capillary barrier. Nitric oxide inhalation may have better results when used at an earlier, less severe stage of acute lung injury.
Shah
N S
NS
Department of Pediatric Surgery, Children's Hospital of Pittsburgh, USA.
Nakayama
D K
DK
Jacob
T D
TD
Nishio
I
I
Imai
T
T
Billiar
T R
TR
Exler
R
R
Yousem
S A
SA
Motoyama
E K
EK
Peitzman
A B
AB
D000280:Administration, Inhalation; D000818:Animals; D004195:Disease Models, Animal; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D009569:Nitric Oxide / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D019301:Oleic Acid; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013552:Swine; D014665:Vasodilator Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*
D014665:Vasodilator Agents; D019301:Oleic Acid; D009569:Nitric Oxide