Inhaled nitric oxide in acute respiratory failure : dose-response curves
To determine the dose-response curve of inhaled nitric oxide (NO) in terms of pulmonary vasodilation and improvement in PaO2 in adults with severe acute respiratory failure. Prospective randomized study. A 14-bed ICU in a teaching hospital. 6 critically ill patients with severe acute respiratory fai...
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| Veröffentlicht in: | Intensive care medicine 1994-05, Vol.20 (5), p.319-327 |
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| creator | PUYBASSET, L ROUBY, J. J MOURGEON, E STEWART, T. E CLUZEL, P ARTHAUD, M POETE, P BODIN, L KORINEK, A. M VIARS, P |
| description | To determine the dose-response curve of inhaled nitric oxide (NO) in terms of pulmonary vasodilation and improvement in PaO2 in adults with severe acute respiratory failure.
Prospective randomized study.
A 14-bed ICU in a teaching hospital.
6 critically ill patients with severe acute respiratory failure (lung injury severity score > or = 2.5) and pulmonary hypertension.
8 concentrations of inhaled NO were administered at random: 100, 400, 700, 1000, 1300, 1600, 1900 and 5000 parts per billion (ppb). Control measurements were performed before NO inhalation and after the last concentration administered. After an NO exposure of 15-20 min, hemodynamic parameters obtained from a fiberoptic Swan-Ganz catheter, blood gases, methemoglobin blood concentrations and intratracheal NO and nitrogen dioxide (NO2) concentrations, continuously monitored using a bedside chemiluminescence apparatus, were recorded on a Gould ES 1000 recorder. In 2 patients end-tidal CO2 was also recorded.
The administration of 100-2000 ppb of inhaled NO induced: i) a dose-dependent decrease in pulmonary artery pressure and in pulmonary vascular resistance (maximum decrease--25%); ii) a dose-dependent increase in PaO2 via a dose-dependent reduction in pulmonary shunt; iii) a slight but significant decrease in PaCO2 via a reduction in alveolar dead space; iv) a dose-dependent increase in mixed venous oxygen saturation (SVO2). Systemic hemodynamic variables and methemoglobin blood concentrations did not change. Maximum NO2 concentrations never exceeded 165 ppb. In 2 patients, 91% and 74% of the pulmonary vasodilation was obtained for inhaled NO concentrations of 100 ppb.
In hypoxemic patients with pulmonary hypertension and severe acute respiratory failure, therapeutic inhaled NO concentrations are in the range 100-2000 ppb. The risk of toxicity related to NO inhalation is therefore markedly reduced. Continuous SVO2 monitoring appears useful at the bedside for determining optimum therapeutic inhaled NO concentrations in a given patient. |
| doi_str_mv | 10.1007/BF01720903 |
| format | Article |
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Prospective randomized study.
A 14-bed ICU in a teaching hospital.
6 critically ill patients with severe acute respiratory failure (lung injury severity score > or = 2.5) and pulmonary hypertension.
8 concentrations of inhaled NO were administered at random: 100, 400, 700, 1000, 1300, 1600, 1900 and 5000 parts per billion (ppb). Control measurements were performed before NO inhalation and after the last concentration administered. After an NO exposure of 15-20 min, hemodynamic parameters obtained from a fiberoptic Swan-Ganz catheter, blood gases, methemoglobin blood concentrations and intratracheal NO and nitrogen dioxide (NO2) concentrations, continuously monitored using a bedside chemiluminescence apparatus, were recorded on a Gould ES 1000 recorder. In 2 patients end-tidal CO2 was also recorded.
The administration of 100-2000 ppb of inhaled NO induced: i) a dose-dependent decrease in pulmonary artery pressure and in pulmonary vascular resistance (maximum decrease--25%); ii) a dose-dependent increase in PaO2 via a dose-dependent reduction in pulmonary shunt; iii) a slight but significant decrease in PaCO2 via a reduction in alveolar dead space; iv) a dose-dependent increase in mixed venous oxygen saturation (SVO2). Systemic hemodynamic variables and methemoglobin blood concentrations did not change. Maximum NO2 concentrations never exceeded 165 ppb. In 2 patients, 91% and 74% of the pulmonary vasodilation was obtained for inhaled NO concentrations of 100 ppb.
In hypoxemic patients with pulmonary hypertension and severe acute respiratory failure, therapeutic inhaled NO concentrations are in the range 100-2000 ppb. The risk of toxicity related to NO inhalation is therefore markedly reduced. Continuous SVO2 monitoring appears useful at the bedside for determining optimum therapeutic inhaled NO concentrations in a given patient.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/BF01720903</identifier><identifier>PMID: 7930025</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Acute Disease ; Administration, Inhalation ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Biological and medical sciences ; Cardiovascular system ; Dose-Response Relationship, Drug ; Female ; Hemodynamics - drug effects ; Humans ; Hypertension, Pulmonary - drug therapy ; Hypertension, Pulmonary - epidemiology ; Hypertension, Pulmonary - physiopathology ; Male ; Medical sciences ; Middle Aged ; Nitric Oxide - administration & dosage ; Pharmacology. Drug treatments ; Prospective Studies ; Respiration, Artificial ; Respiratory Insufficiency - drug therapy ; Respiratory Insufficiency - epidemiology ; Respiratory Insufficiency - physiopathology ; Vasodilator agents. Cerebral vasodilators</subject><ispartof>Intensive care medicine, 1994-05, Vol.20 (5), p.319-327</ispartof><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-7d35fb25de2d5556f72d990371e78dc513ea4ac5f93b550ffdf62f9dbbe411783</citedby><cites>FETCH-LOGICAL-c347t-7d35fb25de2d5556f72d990371e78dc513ea4ac5f93b550ffdf62f9dbbe411783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4101820$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7930025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PUYBASSET, L</creatorcontrib><creatorcontrib>ROUBY, J. J</creatorcontrib><creatorcontrib>MOURGEON, E</creatorcontrib><creatorcontrib>STEWART, T. E</creatorcontrib><creatorcontrib>CLUZEL, P</creatorcontrib><creatorcontrib>ARTHAUD, M</creatorcontrib><creatorcontrib>POETE, P</creatorcontrib><creatorcontrib>BODIN, L</creatorcontrib><creatorcontrib>KORINEK, A. M</creatorcontrib><creatorcontrib>VIARS, P</creatorcontrib><title>Inhaled nitric oxide in acute respiratory failure : dose-response curves</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>To determine the dose-response curve of inhaled nitric oxide (NO) in terms of pulmonary vasodilation and improvement in PaO2 in adults with severe acute respiratory failure.
Prospective randomized study.
A 14-bed ICU in a teaching hospital.
6 critically ill patients with severe acute respiratory failure (lung injury severity score > or = 2.5) and pulmonary hypertension.
8 concentrations of inhaled NO were administered at random: 100, 400, 700, 1000, 1300, 1600, 1900 and 5000 parts per billion (ppb). Control measurements were performed before NO inhalation and after the last concentration administered. After an NO exposure of 15-20 min, hemodynamic parameters obtained from a fiberoptic Swan-Ganz catheter, blood gases, methemoglobin blood concentrations and intratracheal NO and nitrogen dioxide (NO2) concentrations, continuously monitored using a bedside chemiluminescence apparatus, were recorded on a Gould ES 1000 recorder. In 2 patients end-tidal CO2 was also recorded.
The administration of 100-2000 ppb of inhaled NO induced: i) a dose-dependent decrease in pulmonary artery pressure and in pulmonary vascular resistance (maximum decrease--25%); ii) a dose-dependent increase in PaO2 via a dose-dependent reduction in pulmonary shunt; iii) a slight but significant decrease in PaCO2 via a reduction in alveolar dead space; iv) a dose-dependent increase in mixed venous oxygen saturation (SVO2). Systemic hemodynamic variables and methemoglobin blood concentrations did not change. Maximum NO2 concentrations never exceeded 165 ppb. In 2 patients, 91% and 74% of the pulmonary vasodilation was obtained for inhaled NO concentrations of 100 ppb.
In hypoxemic patients with pulmonary hypertension and severe acute respiratory failure, therapeutic inhaled NO concentrations are in the range 100-2000 ppb. The risk of toxicity related to NO inhalation is therefore markedly reduced. Continuous SVO2 monitoring appears useful at the bedside for determining optimum therapeutic inhaled NO concentrations in a given patient.</description><subject>Acute Disease</subject><subject>Administration, Inhalation</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - drug therapy</subject><subject>Hypertension, Pulmonary - epidemiology</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nitric Oxide - administration & dosage</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial</subject><subject>Respiratory Insufficiency - drug therapy</subject><subject>Respiratory Insufficiency - epidemiology</subject><subject>Respiratory Insufficiency - physiopathology</subject><subject>Vasodilator agents. Cerebral vasodilators</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1Lw0AURQdRaq1u3AuzcCVE33xlEndarC0U3Og6TGbe4EialJlE7L83pUVXd3EOj3cvIdcM7hmAfnheANMcShAnZMqk4BnjojglUxCSZzKX_JxcpPQFo5YrNiETXQoArqZkuWo_TYOOtqGPwdLuJzikoaXGDj3SiGkboum7uKPehGaISB-p6xJme9S1Cakd4jemS3LmTZPw6pgz8rF4eZ8vs_Xb62r-tM6skLrPtBPK11w55E4plXvNXTk-rhnqwlnFBBpprPKlqJUC753PuS9dXaNkTBdiRu4Od23sUoroq20MGxN3FYNqv0b1v8Yo3xzk7VBv0P2px_ojvz1yk6xpfDStDelPkwxYwUH8Aq8IZnI</recordid><startdate>19940501</startdate><enddate>19940501</enddate><creator>PUYBASSET, L</creator><creator>ROUBY, J. J</creator><creator>MOURGEON, E</creator><creator>STEWART, T. E</creator><creator>CLUZEL, P</creator><creator>ARTHAUD, M</creator><creator>POETE, P</creator><creator>BODIN, L</creator><creator>KORINEK, A. 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M ; VIARS, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-7d35fb25de2d5556f72d990371e78dc513ea4ac5f93b550ffdf62f9dbbe411783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Acute Disease</topic><topic>Administration, Inhalation</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - drug therapy</topic><topic>Hypertension, Pulmonary - epidemiology</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nitric Oxide - administration & dosage</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial</topic><topic>Respiratory Insufficiency - drug therapy</topic><topic>Respiratory Insufficiency - epidemiology</topic><topic>Respiratory Insufficiency - physiopathology</topic><topic>Vasodilator agents. Cerebral vasodilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PUYBASSET, L</creatorcontrib><creatorcontrib>ROUBY, J. J</creatorcontrib><creatorcontrib>MOURGEON, E</creatorcontrib><creatorcontrib>STEWART, T. E</creatorcontrib><creatorcontrib>CLUZEL, P</creatorcontrib><creatorcontrib>ARTHAUD, M</creatorcontrib><creatorcontrib>POETE, P</creatorcontrib><creatorcontrib>BODIN, L</creatorcontrib><creatorcontrib>KORINEK, A. M</creatorcontrib><creatorcontrib>VIARS, P</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PUYBASSET, L</au><au>ROUBY, J. J</au><au>MOURGEON, E</au><au>STEWART, T. E</au><au>CLUZEL, P</au><au>ARTHAUD, M</au><au>POETE, P</au><au>BODIN, L</au><au>KORINEK, A. M</au><au>VIARS, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inhaled nitric oxide in acute respiratory failure : dose-response curves</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>1994-05-01</date><risdate>1994</risdate><volume>20</volume><issue>5</issue><spage>319</spage><epage>327</epage><pages>319-327</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>To determine the dose-response curve of inhaled nitric oxide (NO) in terms of pulmonary vasodilation and improvement in PaO2 in adults with severe acute respiratory failure.
Prospective randomized study.
A 14-bed ICU in a teaching hospital.
6 critically ill patients with severe acute respiratory failure (lung injury severity score > or = 2.5) and pulmonary hypertension.
8 concentrations of inhaled NO were administered at random: 100, 400, 700, 1000, 1300, 1600, 1900 and 5000 parts per billion (ppb). Control measurements were performed before NO inhalation and after the last concentration administered. After an NO exposure of 15-20 min, hemodynamic parameters obtained from a fiberoptic Swan-Ganz catheter, blood gases, methemoglobin blood concentrations and intratracheal NO and nitrogen dioxide (NO2) concentrations, continuously monitored using a bedside chemiluminescence apparatus, were recorded on a Gould ES 1000 recorder. In 2 patients end-tidal CO2 was also recorded.
The administration of 100-2000 ppb of inhaled NO induced: i) a dose-dependent decrease in pulmonary artery pressure and in pulmonary vascular resistance (maximum decrease--25%); ii) a dose-dependent increase in PaO2 via a dose-dependent reduction in pulmonary shunt; iii) a slight but significant decrease in PaCO2 via a reduction in alveolar dead space; iv) a dose-dependent increase in mixed venous oxygen saturation (SVO2). Systemic hemodynamic variables and methemoglobin blood concentrations did not change. Maximum NO2 concentrations never exceeded 165 ppb. In 2 patients, 91% and 74% of the pulmonary vasodilation was obtained for inhaled NO concentrations of 100 ppb.
In hypoxemic patients with pulmonary hypertension and severe acute respiratory failure, therapeutic inhaled NO concentrations are in the range 100-2000 ppb. The risk of toxicity related to NO inhalation is therefore markedly reduced. Continuous SVO2 monitoring appears useful at the bedside for determining optimum therapeutic inhaled NO concentrations in a given patient.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>7930025</pmid><doi>10.1007/BF01720903</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 1994-05, Vol.20 (5), p.319-327 |
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| subjects | Acute Disease Administration, Inhalation Adult Aged Aged, 80 and over Analysis of Variance Biological and medical sciences Cardiovascular system Dose-Response Relationship, Drug Female Hemodynamics - drug effects Humans Hypertension, Pulmonary - drug therapy Hypertension, Pulmonary - epidemiology Hypertension, Pulmonary - physiopathology Male Medical sciences Middle Aged Nitric Oxide - administration & dosage Pharmacology. Drug treatments Prospective Studies Respiration, Artificial Respiratory Insufficiency - drug therapy Respiratory Insufficiency - epidemiology Respiratory Insufficiency - physiopathology Vasodilator agents. Cerebral vasodilators |
| title | Inhaled nitric oxide in acute respiratory failure : dose-response curves |
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