Beneficial effects of inhaled nitric oxide in adult cardiac surgical patients.
BACKGROUND
Pulmonary hypertension with associated right ventricular dysfunction may complicate the postoperative cardiac patient despite maximum pharmacologic and ventilatory support. The purpose of this study was to retrospectively review our experience with inhaled nitric oxide (INO) in adult postoperative cardiac patients with pulmonary hypertension.


METHODS
We retrospectively reviewed the medical records of 17 adult cardiac patients treated with INO postoperatively between November 1998 and February 2000. The INO was used to manage pulmonary hypertension postoperatively in patients who had undergone coronary artery bypass graft (CABG) (n = 13), valve operation (n = 3), and combined CABG/aortic valve replacement (n = 1). Hemodynamic and respiratory measurements before INO and again 6 hours after administration were examined. Student's t test was used to analyze the data.


RESULTS
Inhaled nitric oxide (20 ppm to 30 ppm) was administered for a median duration of 30.2 hours. The group, as a whole, demonstrated a significant decrease in both mean pulmonary artery pressure and right ventricular stroke work index. In addition, a significant increase in posttherapeutic cardiac index and Pao2/Fio2 ratio was observed. The vasodilatory effects of nitric oxide were specific to the pulmonary circulation as no significant change in mean arterial pressure was noted. Overall mortality was 6%.


CONCLUSIONS
Inhaled nitric oxide effectively and selectively lowered right ventricular afterload and right ventricular work in critically ill adult cardiac patients with acute pulmonary hypertension.
Maxey
Thomas S
TS
Department of Surgery, University of Virginia Health Care System, Charlottesville 22908, USA.
Smith
Christopher D
CD
Kern
John A
JA
Tribble
Curtis G
CG
Jones
David R
DR
Kron
Irving L
IL
Crosby
Ivan K
IK
D000280:Administration, Inhalation; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy*
D009569:Nitric Oxide; D010100:Oxygen