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Nitric oxide 2

1996; Springer Science+Business Media; Volume: 22; Issue: S2 Linguagem: Inglês

10.1007/bf03216380

1432-1238

G Zobel, Andreas Gamillscheg, Berndt Urlesberger, Siegfried Rödl, D Dacar, Johann Berger, H. Metzler, A Beitzke, B. Rigler, M. Trop, H. M. Grubbauer, Allan P. Goldman, Robert C. Tasker, Stephan Hosiasson, Thore Henrichsen, Duncan Macrae, Philippe Jouvet, Jean‐Marc Tréluyer, Ernst R. Werner, Philippe Hubert, J. Pfenninger, Denis Bachmann, B. P. Wagner, Sylvia Göthberg, Karl Erik Edberg, Swee Fong Tang, Daniel Holmgren, S. Michelsen, Owen Miller, Erik Thaulow, Per Winberg, Per‐Arne Lönnqvist, Paolo Biban, Andrea Pettenazzo, Daniele Trevisanuto, P. Ferrarese, Franco Zacchello,

Electron Spin Resonance Studies

Objective: To evaluate gas exchange, pulmonary mechanics and hemodynamic data during partial liquid ventilation (PLV) combined with inhaled nitric oxide (NO) in acute respiratory failure with pulmonary hypertension.Design: Prospective, randomized, controlled study.Setting: University research laboratory.Subjects: Twelve piglets weighing 9 to 13 kg.Interventions: Acute respiratory failure with pulmonary hypertension was induced by repeated lung lavages and a continuous infusion of the stable endoperoxane analogue of thromboxane.Thereafter the animals were randomly assigned either for PLV or conventional mechanical ventilation.Initially perfluorocarbon liquid (30m1/kg) was instilled into the endotracheal tube over 5 min followed by 5-10m1/kg/h.All animals were treated with different concentrations of NO (1-10-20 ppm) inhaled in random order.Measurements and results: Continuous monitoring included ECG, CVP, MPAP, MAP, SaO2 and SvO2 measurements.During PLV PaO2/FiO2 increased significantly from 62±3.2 mmHg to 193144 mmHg (p<0.01)within 10 min, while Pa02/FiO2 remained constant at 61±3.3mmHg.Qs/Qt decreased significantly from 48±4% to 25±5% (p<0.01)during PLV and did not change during conventional mechanical ventilation.Static pulmonary compliance (Cstat) increased sionificontly frrm 0.4P.-!1.02 to 0.75±0.03mlcmH2O/kg (p<0.01)during PLV and decreased slightly from 0.58±0.08 to 0.46±0.04ml/emH2O/kg during conventional mechanical ventilation.The infusion of the endoperoxane analogue resulted in a sudden decrease of PaO2/FiO2 from 262±44 to 106±8.0 mmHg in the PLV group and from 71±7 to 52±2.0 mmHg in the control group.Inhaled NO significantly improved oxygenation in both groups (PaO2/FiO2: 344±38 mmHg during PLV and 1966 mmHg during conventional mechanical ventilation).During inhalation of NO MPAP decreased significantly from 57±2 to 35±2 mmHg (p<0.01) in both groups.There was no significant change in oxygenation and MPAP during inhalation of I and 20 ppm NO.Conclusions: PLV significantly improves oxygenation and pulmonary compliance in acute respiratory failure.The additional application of inhaled NO further improves oxygenation and pulmonary hemodynamics when acute respiratory failure is associated with severe pulmonary hypertension.Inhaled NO is very effective in improving oxygenation and pulmonary blood flow even at low doses.