Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion.
We report a severe head injury and blunt chest trauma with sternal and multiple rib fractures with high-energy impact in a 22-year-old man. Twelve hours after the accident, haemodynamic status of the patient rapidly worsened because of right ventricular (RV) failure due to myocardial contusion, requiring increasing doses of catecholamine. Nitric oxide inhalation was used to decrease RV afterload, and produced an immediate improvement in haemodynamic status, permitting a decrease in catecholamine administration. From days 2 through 8, cardiac function continued to improve, and was normal on day 9. Nitric oxide inhalation was stopped on day 4.
Meaudre
E
E
Intensive Care Unit, Military Teaching Hospital, Hôpital d'Instruction des Armées Sainte Anne, 83800 Toulon-Naval, France. meaudre@club-internet.fr
Goutorbe
P
P
Boret
H
H
Kaiser
E
E
Salinier
L
L
Cantais
E
E
Palmier
B
B
D000063:Accidents, Traffic; D000280:Administration, Inhalation; D000328:Adult; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002395:Catecholamines / Q000627:therapeutic use; D003288:Contusions / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000379:methods; D004837:Epinephrine / Q000627:therapeutic use; D017809:Fatal Outcome; D016489:Head Injuries, Closed / Q000209:etiology; D006335:Heart Injuries / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D009638:Norepinephrine / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000150:complications; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology*; D014949:Wounds, Nonpenetrating / Q000150:complications
D001993:Bronchodilator Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D009569:Nitric Oxide; D009638:Norepinephrine; D004837:Epinephrine