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Clinical Trial
. 2001 Dec;5(6):355-61.
doi: 10.1186/cc1069. Epub 2001 Oct 9.

Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension

C D Vizza  1 , G D Rocca, A D Roma, C Iacoboni, F Pierconti, F Venuta, E Rendina, G Schmid, P Pietropaoli, F Fedele
Affiliations
Clinical Trial

Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension

C D Vizza et al. Crit Care. 2001 Dec.

Abstract

Introduction: The use of low-dose dobutamine to maintain hemodynamic stability in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO), dobutamine and a combination of the two have beneficial effects in patients with end-stage airway lung disease and pulmonary hypertension.

Method: Hemodynamic evaluation was assessed 10 min after the administration of each drug and of their combination, in 28 candidates for lung transplantation.

Results: Administration of INO caused a reduction in mean pulmonary arterial pressure (MPAP), an increase in PaO2 with a significant reduction in venous admixture effect (Qs/Qt).Dobutamine administration caused an increase in cardiac index and MPAP, with a decrease in PaO2 as a result of a higher Qs/Qt. Administration of a combination of the two drugs caused an increase in the cardiac index without MPAP modification and an increase in PaO2 and Qs/Qt.

Conclusion: Dobutamine and INO have complementary effects on pulmonary circulation. Their association may be beneficial in the treatment of patients with mild to moderate pulmonary hypertension.

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Figures

Figure 1
Figure 1
Flow-pressure diagram showing the difference of MPAP and PAOP (MPAP-PAOP) and cardiac index. The dashed lines indicate the isoresistance lines from 600 to 300 dyne/s/cm5. INO, inhaled nitric oxide; MPAP, mean pulmonary arterial pressure; PAOP, pulmonary artery occluded pressure.
Figure 2
Figure 2
Decisional algorithm according to the different values of cardic index and the different values of MPAP and PAOP (MPAP-PAOP) in cases of acute cardiac decompensation. =, low TPG; ↑, moderate TPG; ↑↑, high TPG. INO, inhaled nitric oxide; MPAP, mean pulmonary arterial pressure; PAOP, pulmonary artery occluded pressure; TPG, transpulmonary gradient.
See this image and copyright information in PMC

Comment in

  • Pulmonary hypertension associated with COPD.
    Naeije R, Barberà JA. Naeije R, et al. Crit Care. 2001 Dec;5(6):286-9. doi: 10.1186/cc1049. Epub 2001 Nov 3. Crit Care. 2001. PMID: 11737906 Free PMC article.
  • Inhaled nitric oxide.
    Watson CM, Reight I, Nottingham JM. Watson CM, et al. Curr Surg. 2005 Jul-Aug;62(4):396-9. doi: 10.1016/j.cursur.2004.11.007. Curr Surg. 2005. PMID: 15964463 No abstract available.

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