Collective Review: Perioperative Uses of Inhaled Nitric Oxide in Adults
DOI:
https://doi.org/10.1532/HSF98.20041136Abstract
Pulmonary arterial hypertension and hypoxemia constitute a significant cause of postoperative right heart failure and mortality. Timely administration of inhaled nitric oxide (iNO) can improve hemodynamic parameters and oxygenation in patients undergoing heart and/or lung transplantation and various high-risk cardiac procedures involving coronary artery bypass grafting and/or left ventricular assist device placement. As a diagnostic tool, iNO can be used to identify heart transplant recipients at high risk of right ventricular failure and patients with primary pulmonary hypertension who may benefit from vasodilator therapy. In addition to its role as a potent and selective pulmonary vasodilator, iNO is a useful intraoperative adjunct in adult cardiac surgery patients that may reduce the need for right ventricular assist device placement. This review focuses on the multiple clinical applications of iNO in perioperative patient care.References
Meade MO, Granton JT, Matte-Martyn A, et al. 2003. A randomized trial of inhaled nitric oxide to prevent ischemia-reperfusion injury after lung transplantation. Am J Respir Crit Care Med 167:1483-9.nOlschewski H. 2002. Inhaled iloprost for treatment of pulmonary arterial hypertension. Adv Pulm Hypertens 1:16-21.nOlschewski H, Simonneau G, Galie N, et al. 2002. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med 347:322-9.nRicciardi MJ, Knight BP, Martinez FJ, Rubenfire M. 1998. Inhaled nitric oxide in primary pulmonary hypertension: a safe and effective agent for predicting response to nifedipine. J Am Coll Cardiol 32:1068-73.nRich S, Kaufmann E, Levy PS. 1992. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med 327:76-81.nRoberts JD Jr, Fineman JR, Morin FC 3rd, et al. 1997. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. N Engl J Med 336:605-10.nRossaint R, Gerlach H, Schmidt-Ruhnke H, et al. 1995. Efficacy of inhaled nitric oxide in patients with severe ARDS. Chest 107:1107-15.nCornfield DN, Milla CE, Haddad IY, Barbato JE, Park SJ. 2003. Safety of inhaled nitric oxide after lung transplantation. J Heart Lung Transplant 22:903-7.nCostard-Jackle A, Fowler MB. 1992. Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group. J Am Coll Cardiol 19:48-54.nDate H, Triantafillou AN, Trulock EP, Pohl MS, Cooper JD, Patterson GA. 1996. Inhaled nitric oxide reduces human lung allograft dysfunction. J Thorac Cardiovasc Surg 111:913-9.nDe Wet CJ, Affleck DG, Jacobsohn E, et al. 2004. Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery. J Thorac Cardiovasc Surg 127:1058-67.nDellinger RP, Zimmerman JL, Taylor RW, et al. 1998. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med 26:15-23.nAtz AM, Adatia I, Lock JE, Wessel DL. 1999. Combined effects of nitric oxide and oxygen during acute pulmonary vasodilator testing. J Am Coll Cardiol 33:813-9.nCockrill BA, Kacmarek RM, Fifer MA, et al. 2001. Comparison of the effects of nitric oxide, nitroprusside, and nifedipine on hemodynamics and right ventricular contractility in patients with chronic pulmonary hypertension. Chest 119:128-36.nArgenziano M, Choudhri AF, Moazami N, et al. 1998. Randomized, double-blind trial of inhaled nitric oxide in LVAD recipients with pulmonary hypertension. Ann Thorac Surg 65:340-5.nBeck JR, Mongero LB, Kroslowitz RM, et al. 1999. Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery. Perfusion 14:37-42.nAuler JO Jr, Carmona MJC, Bocchi EA, et al. 1996. Low doses of inhaled nitric oxide in heart transplant recipients. J Heart Lung Transplant 15:443-50.nBender KA, Alexander JA, Enos JM, Skimming JW. 1997. Effects of inhaled nitric oxide in patients with hypoxemia and pulmonary hypertension after cardiac surgery. Am J Crit Care 6:127-31.nHart CM. 1999. Nitric oxide in adult lung disease. Chest 115:1407-17. Hoeper MM, Olschewski H, Ghofrani HA, et al. 2000. A comparison of the acute hemodynamic effects of inhaled nitric oxide and aerosolizediloprost in primary pulmonary hypertension: German PPH Study Group. J Am Coll Cardiol 35:176-82.nKieler-Jensen N, Lundin S, Ricksten S-E. 1995. Vasodilator therapy after heart transplantation: effects of inhaled nitric oxide and intravenous prostacyclin, prostaglandin E, and sodium nitroprusside. J Heart Lung Transplant 14:436-43.nLepore JJ, Maroo A, Pereira NL, et al. 2002. Effect of sildenafil on the acute pulmonary vasodilator response to inhaled nitric oxide in adults with primary pulmonary hypertension. Am J Cardiol 90:677-80.nLoh E, Stamler JS, Hare JM, Loscalzo J, Colucci WS. 1994. Cardiovascular effects of inhaled nitric oxide in patients with left ventricular dysfunction. Circulation 90:2780-5.nMacdonald P, Mundy J, Rogers P, et al. 1995. Successful treatment of life-threatening acute reperfusion injury after lung transplantation with inhaled nitric oxide. J Thorac Cardiovasc Surg 110:861-3.nMaxey TS, Smith CD, Kern JA, et al. 2002. Beneficial effects of inhaled nitric oxide in adult cardiac surgical patients. Ann Thorac Surg 73:529-33.nAdatia I, Lillehei C, Arnold JH, et al. 1994. Inhaled nitric oxide in the treatment of postoperative graft dysfunction after lung transplantation. Ann Thorac Surg 57:1311-8.nAddonizio LJ, Gersony WM, Robbins RC, et al. 1987. Elevated pulmonary vascular resistance and cardiac transplantation. Circulation 76:V-52-5.nAngus DC, Clermont G, Watson RS, Linde-Zwirble WT, Clark RH, Roberts MS. 2003. Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics 112:1351-60.nArdehali A, Hughes K, Sadeghi A, et al. 2001. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation 72:638-41.nArdehali A, Laks H, Levine M, et al. 2001. A prospective trial of inhaled nitric oxide in clinical lung transplantation. Transplantation 72:112-5.nChristenson J, Lavoie A, O'Connor M, Bhorade S, Pohlman A, Hall JB. 2000. The incidence and pathogenesis of cardiopulmonary deterioration after abrupt withdrawal of inhaled nitric oxide. Am J Respir Crit Care Med 161:1443-9.nBhatia SJ, Kirshenbaum JM, Shemin RJ, et al. 1987. Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation. Circulation 76:819-26.nDweik RA, Laskowski D, Abu-Soud HM, et al. 1998. Nitric oxide synthesis in the lung: regulation by oxygen through a kinetic mechanism. J Clin Invest 101:660-6.nFiser SM, Cope JT, Kron IL, et al. 2001. Aerosolized prostacyclin (epoprostenol) as an alternative to inhaled nitric oxide for patients with reperfusion injury after lung transplantation. J Thorac Cardiovasc Surg 121:981-2.nFullerton DA, Jones SD, Jaggers J, Piedalue F, Grover FL, McIntyre RC Jr. 1996. Effective control of pulmonary vascular resistance with inhaled nitric oxide after cardiac operation. J Thorac Cardiovasc Surg 111:753-63.nGerlach H, Rossaint R, Pappert D, Knorr M, Falke KJ. 1994. Autoinhalation of nitric oxide after endogenous synthesis in nasopharynx. Lancet 343:518-9.nGhofrani HA, Wiedemann R, Rose F, et al. 2002. Combination therapy with oral sildenafil and inhaled iloprost for severe pulmonary hypertension. Ann Intern Med 136:515-22.nGirard C, Lehot J-J, Pannetier J-C, Filley S, Ffrench P, Estanove S. 1992. Inhaled nitric oxide after mitral valve replacement in patients with chronic pulmonary artery hypertension. Anesthesiology 77:880-3.nHaraldsson A, Kieler-Jensen N, Nathorst-Westfelt U, Bergh CH, Ricksten SE. 1998. Comparison of inhaled nitric oxide and inhaled aerosolized prostacyclin in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance. Chest 114:780-6.nSablotzki A, Czeslick E, Gruenig E, et al. 2003. First experiences with the stable prostacyclin analog iloprost in the evaluation of heart transplant candidates with increased pulmonary vascular resistance. J Thorac Cardiovasc Surg 125:960-2.nSchmid ER, Burki C, Engel MHC, Schmidlin D, Tornic M, Seifert B. 1999. Inhaled nitric oxide versus intravenous vasodilators in severe pulmonary hypertension after cardiac surgery. Anesth Analg 89:1108-15.nSemigran MJ, Cockrill BA, Kacmarek R, et al. 1994. Hemodynamic effects of inhaled nitric oxide in heart failure. J Am Coll Cardiol 24:982-8.nZapol WM, Rimar S, Gillis N, Marletta M, Bosken CH. 1994. Nitric oxide and the lung. Am J Respir Crit Care Med 149:1375-80.nZwissler B, Kemming G, Habler O, et al. 1996. Inhaled prostacyclin (PGI) versus inhaled nitric oxide in adult respiratory distress syndrome. Am J Respir Crit Care Med 154:1671-7.n
