Combination of inhaled nitric oxide and intravenous prostacyclin for successful treatment of severe pulmonary hypertension in a patient with acute respiratory distress syndrome.
OBJECTIVE
To investigate the combination of inhaled nitric oxide (iNO) and intravenously administered prostacyclin (i.v. PGI2) in a patient with severe pulmonary hypertension and acute respiratory distress syndrome (ARDS).


METHODS
Single case study.


METHODS
Intensive care unit of a university hospital.


METHODS
In an ARDS patient with severe pulmonary hypertension, gas exchange and hemodynamics were measured during combined treatment with iNO and i.v. PGI2. On two subsequent days, a protocol consisting of four 20-min periods was performed: baseline, 10 ppm iNO, 10 ppm iNO plus 4 ng kg-1 min-1, and 4 ng kg-1 min-1 PGI2 alone. At the end of each period hemodynamic and gas exchange data were obtained.


RESULTS
The combination of iNO and i.v. PGI2 resulted in a marked decrease in pulmonary artery pressure and a concomitant increase in cardiac output which was more pronounced than the effect of either drug alone. During iNO, as well as during the combination of iNO and i.v. PGI2, oxygenation was improved, whereas during i.v. PGI2 alone oxygenation was worse than baseline.


CONCLUSIONS
We conclude that the combination of iNO and i.v. PGI2 might be more useful than either drug alone when severe pulmonary hypertension leading to impaired right ventricular function is present in ARDS. A systematic study of this observation is warranted.
Kuhlen
R
R
Department of Anesthesiology, University Hospital Aachen, Germany. Ralf Kuhlen@post.rwth-aachen.de
Walbert
E
E
Fränkel
P
P
Thaden
S
S
Behrendt
W
W
Rossaint
R
R
D000280:Administration, Inhalation; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000150:complications*
D000959:Antihypertensive Agents; D001993:Bronchodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol