Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension.
BACKGROUND
The use of low-dose dobutamine to maintain hemodynamic stability in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO), dobutamine and a combination of the two have beneficial effects in patients with end-stage airway lung disease and pulmonary hypertension.


METHODS
Hemodynamic evaluation was assessed 10 min after the administration of each drug and of their combination, in 28 candidates for lung transplantation.


RESULTS
Administration of INO caused a reduction in mean pulmonary arterial pressure (MPAP), an increase in PaO2 with a significant reduction in venous admixture effect (Qs/Qt).Dobutamine administration caused an increase in cardiac index and MPAP, with a decrease in PaO2 as a result of a higher Qs/Qt. Administration of a combination of the two drugs caused an increase in the cardiac index without MPAP modification and an increase in PaO2 and Qs/Qt.


CONCLUSIONS
Dobutamine and INO have complementary effects on pulmonary circulation. Their association may be beneficial in the treatment of patients with mild to moderate pulmonary hypertension.
Vizza
C D
CD
Department of Cardiovascular and Respiratory Sciences, University of Rome 'La Sapienza', Rome, Italy.
Rocca
G D
GD
Roma
A D
AD
Iacoboni
C
C
Pierconti
F
F
Venuta
F
F
Rendina
E
E
Schmid
G
G
Pietropaoli
P
P
Fedele
F
F
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D016037:Single-Blind Method; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D009569:Nitric Oxide; D004280:Dobutamine