title: Doppler study of the effects of inhaled nitric oxide and intravenous almitrine on regional pulmonary blood flows in patients with acute lung injury.
abstract: BACKGROUND
  Lung ultrasound can be used at bedside to assess initial lung morphology in hypoxemic patients. We hypothesized that blood flow in consolidated lung and therefore effects of inhaled nitric oxide (iNO) and intravenous almitrine could be directly assessed using Doppler transesophageal echocardiography (TEE).
  
  
  METHODS
  We conducted a prospective study including 13 ALI patients with consolidated left lower lobe (LLL). Regional arterial and venous flow signals within the consolidation were recorded with TEE using Doppler at baseline, after iNO (5 ppm), almitrine (4 μg/kg/min) and their combination. Pulmonary shunt (Qs/Qt) was measured using a Swan-Ganz catheter. Arterial and venous velocity time integral (VTI), peak velocity (Vmax) and mean velocity (Vmean) were measured. Patients were responders if PaO2 basal value increased by 20% after iNO or almitrine.
  
  
  RESULTS
  In 7 NO responders, iNO decreased regional arterial VTI (8.1±1.9 vs. 6.7±1.6, P<0.05). In 8 almitrine responders, almitrine decreased regional arterial and venous VTI (from 6.7±2.0 to 4.5±2.3 cm and from 12.3±5.4 to 7.5±3.8 cm, respectively, P<0.05). For all patients, combination of iNO and almitrine decreased regional arterial and venous VTI (from 7.3±0.3 to 4.1±0.3 cm and from 12.6±0.7 to 6.7±0.8 cm, respectively, P<0.05). Arterial and venous Vmean and Vmax significantly decreased. Variations of arterial VTI and venous Vmean were correlated to variations of Qs/Qt (r=.71, P<.001 and r=.62, P<.01, respectively).
  
  
  CONCLUSIONS
  Doppler of consolidated LLL allows assessment of regional pulmonary circulation in ICU settings. It detects changes in flow profiles resulting from the administration of NO and/or almitrine. Further applicability remains to be determined.
authors.affiliation: Réanimation Chirurgicale, Département d'Anesthésie-Réanimation, Groupe Hospitalier Paris Saint Joseph, Paris, Cedex 14 France - belaid_bouhemad@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Bouhemad
authors.forename: T
authors.initials: T
authors.lastname: Barbry
authors.forename: A
authors.initials: A
authors.lastname: Soummer
authors.forename: Q
authors.initials: Q
authors.lastname: Lu
authors.forename: J J
authors.initials: JJ
authors.lastname: Rouby
mesh_terms: D055371:Acute Lung Injury / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D000280:Administration, Inhalation; D000368:Aged; D015765:Almitrine / Q000008:administration & dosage / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D011652:Pulmonary Circulation / Q000187:drug effects*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000503:physiopathology; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D019141:Respiratory System Agents; D009569:Nitric Oxide; D015765:Almitrine