CLINICAL STUDIES
Combined effects of nitric oxide and oxygen during acute pulmonary vasodilator testing
Andrew M. Atz, MDa,
Ian Adatia, FRCP(C)b,
James E. Lock, MD, FACCc and
David L. Wessel, MDc
a Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
b Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
c Harvard Medical School, Boston, Massachusetts, USA
Manuscript received April 10, 1998;
revised manuscript received September 18, 1998,
accepted October 30, 1998.
Reprint requests and correspondence: Dr. David L. Wessel, Cardiac ICU Office, Farley 653, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115
wessel{at}a1.tch.harvard.edu
OBJECTIVES
We compared the ability of inhaled nitric oxide (NO), oxygen (O2) and nitric oxide in oxygen (NO+O2) to identify reactive pulmonary vasculature in pulmonary hypertensive patients during acute vasodilator testing at cardiac catheterization.
BACKGROUND
In patients with pulmonary hypertension, decisions regarding suitability for corrective surgery, transplantation and assessment of long-term prognosis are based on results obtained during acute pulmonary vasodilator testing.
METHODS
In group 1, 46 patients had hemodynamic measurements in room air (RA), 100% O2, return to RA and NO (80 parts per million [ppm] in RA). In group 2, 25 additional patients were studied in RA, 100% O2 and 80 ppm NO in oxygen (NO+O2).
RESULTS
In group 1, O2 decreased pulmonary vascular resistance (PVR) (mean ± SEM) from 17.2 ± 2.1 U·m2 to 11.1 ± 1.5 U·m2 (p < 0.05). Nitric oxide caused a comparable decrease from 17.8 ± 2.2 U·m2 to 11.7 ± 1.7 U·m2 (p < 0.05). In group 2, PVR decreased from 20.1 ± 2.6 U·m2 to 14.3 ± 1.9 U·m2 in O2 (p < 0.05) and further to 10.5 ± 1.7 U·m2 in NO+O2 (p < 0.05). A response of 20% or more reduction in PVR was seen in 22/25 patients with NO+O2 compared with 16/25 in O2 alone (p = 0.01).
CONCLUSIONS
Inhaled NO and O2 produced a similar degree of selective pulmonary vasodilation. Our data suggest that combination testing with NO+O2 provides additional pulmonary vasodilation in patients with a reactive pulmonary vascular bed in a selective, safe and expeditious fashion during cardiac catheterization. The combination of NO+O2 identifies patients with significant pulmonary vasoreactivity who might not be recognized if O2 or NO were used separately.
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Abbreviations and Acronyms
| | FiO2 | = fraction of inspired oxygen | | NO | = nitric oxide | | NO2 | = nitrogen dioxide | | O2 | = oxygen | | PaCO2 | = partial pressure of carbon dioxide, arterial | | PCO2 | = partial pressure of carbon dioxide | | ppm | = parts per million | | PVR | = pulmonary vascular resistance | | RA | = room air |
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