Effect of inhaled nitric oxide in combination with almitrine on ventilation-perfusion distributions in experimental lung injury.
OBJECTIVE
To investigate a possible additive effect of combined nitric oxide (NO) and almitrine bismesylate (ALM) on pulmonary ventilation-perfusion (V(A)/Q) ratio.


METHODS
Prospective, controlled animal study.


METHODS
Animal research facility of a university hospital.


METHODS
Three conditions were studied in ten female pigs with experimental acute lung injury (ALI) induced by repeated lung lavage: 1) 10 ppm NO, 2) 10 ppm NO with 1 microg/kg per min ALM, 3) 1 microg/ kg per min ALM. For each condition, gas exchange, hemodynamics and V(A)/Q distributions were analyzed using the multiple inert gas elimination technique (MIGET).


RESULTS
With NO + ALM, arterial oxygen partial pressure (PaO2) increased from 63 +/- 18 mmHg to 202 +/- 97 mmHg while intrapulmonary shunt decreased from 50 +/- 15 % to 26 +/- 12% and blood flow to regions with a normal V(A)/Q ratio increased from 49 +/- 16 % to 72 +/- 15 %. These changes were significant when compared to untreated ALI (p < 0.05) and NO or ALM alone (p < 0.05), although improvements due to NO or ALM also reached statistical significance compared to ALI values (p < 0.05).


CONCLUSIONS
We conclude that NO + ALM results in an additive improvement of pulmonary gas exchange in an experimental model of ALI by diverting additional blood flow from non-ventilated lung regions towards those with normal V(A)/Q relationships.
Dembinski
R
R
Klinik für Anästhesie, Medizinische Einrichtungen der Rheinisch-Westfälischen Technischen, Hochschule Aachen, Germany. Rolf.Dembinski@post.rwth-aachen.de
Max
M
M
Lopez
F
F
Kuhlen
R
R
Sünner
M
M
Rossaint
R
R
D000280:Administration, Inhalation; D015765:Almitrine / Q000008:administration & dosage / Q000494:pharmacology*; D000704:Analysis of Variance; D000818:Animals; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D055370:Lung Injury; D009569:Nitric Oxide / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000503:physiopathology*; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000494:pharmacology*; D013552:Swine; D014692:Ventilation-Perfusion Ratio / Q000187:drug effects*
D001993:Bronchodilator Agents; D019141:Respiratory System Agents; D009569:Nitric Oxide; D015765:Almitrine