A comparison of the acute hemodynamic effects of inhaled nitric oxide and aerosolized iloprost in primary pulmonary hypertension

Hoeper, Marius M.; Olschewski, Horst; Ghofrani, Hossein Ardeschir; Wilkens, Heinrike; Winkler, J; Borst, Mathias M.; Niedermeyer, J; Fabel, H; Seeger, Werner

doi:10.1016/s0735-1097(99)00494-5

Cited by 290 publications

(206 citation statements)

References 24 publications

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“…2 As an alternative, inhaled nitric oxide possesses pulmonary selectivity, but it is less potent than prostacyclin in the pulmonary vasculature. 3,4 Moreover, an interruption in the inhalation of continuous nitric oxide may cause rebound pulmonary hypertension. 5,6 Designed to combine the beneficial effects of prostacyclin with those of an inhalational application, aerosolized prostacyclin was found to be a potent pulmonary vasodilator in patients with acute respiratory failure, exerting preferential vasodilatation in well-ventilated lung regions.…”

Section: Resultsmentioning

confidence: 99%

“…12 When administered during a short aerosolization ma-neuver to patients with pulmonary hypertension, its pulmonary vasodilative potency was similar to that of prostacyclin, but its effects lasted for 30 to 90 minutes, as compared with 15 minutes. 4,11,[13][14][15] Several open-label, uncontrolled studies of patients with severe pulmonary hypertension suggested that longterm use of aerosolized iloprost results in substantial clinical improvement. 11,13,[16][17][18][19][20] Our objective in this trial was to evaluate the effects of inhaled iloprost using a rigorous end point of clinical efficacy.…”

Section: Resultsmentioning

confidence: 99%

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Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

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“…Although it may be possible to administer iloprost intravenously, the drug has gained attention recently for delivery by inhalation. In idiopathic PAH, short-term inhalation of iloprost resulted in greater pulmonary vasodilatation than did nitric oxide (65). For long-term use, the relatively short duration of action of inhaled iloprost necessitates 6 to 9 inhalations per day (66,67).…”

Section: Prostanoidsmentioning

confidence: 99%

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Rubin

Badesch²

2005

Ann Intern Med

126

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Increased pressure in the pulmonary circulation, or pulmonary hypertension, is a common disorder that may complicate various cardiopulmonary conditions, including severe obstructive airways disease and left ventricular dysfunction. An increase in pulmonary arterial pressure that is not due to coexistent cardiopulmonary disease, known as pulmonary arterial hypertension, may occur in the absence of a demonstrable cause (idiopathic or familial); as a complication of systemic conditions, such as connective tissue disease, HIV infection, or chronic liver disease; or as a result of the use of fenfluramine anorexigens, amphetamines, or cocaine. The development of disease-specific therapies for pulmonary arterial hypertension over the past decade underscores the importance of diagnosing pulmonary hypertension early in the course of the condition and implementing a treatment strategy that is based on the condition's cause and severity. In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a hypothetical case to highlight the key management points. U ntil recently, management of pulmonary arterial hypertension (PAH) was generally ineffective in alleviating symptoms or improving survival. However, the past decade has witnessed remarkable advances in our understanding of the pathogenesis of PAH, advances that have led to the development of disease-specific treatments. Despite these achievements, PAH remains a challenging condition to diagnose and manage. This article reviews recent developments in the diagnosis and management of PAH in the context of a typical case, illustrating the importance of collaboration between the internist and the specialist in patient care.

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“…Bolus doses between 15 and 30 µg of inhaled prostacyclin have been administered in humans with potent effects on pulmonary pressure and oxygenation. 89,90 Inhaled NO and prostacyclin may have additive actions as both medications act through different vasodilatory pathways. 91 Endothelin-1 is a potent vasoconstrictor released by endothelial cells in the pathophysiology of pulmonary hypertension.…”

Section: Rebound Pulmonary Hypertension and Hypoxemiamentioning

confidence: 99%

Inhaled nitric oxide in 2003: a review of its mechanisms of action

Wang

Kebir

Blaise

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To review the pulmonary and systemic effects of endogenous nitric oxide and inhaled nitric oxide administered to patients.S So ou ur rc ce e: : A systematic search for experimental data, human case reports, and randomized clinical trials since 1980, the year of discovery of endothelium-derived relaxing factor. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Nitric oxide has pulmonary and systemic effects. Inhaled nitric oxide not only causes selective pulmonary vasodilation but also results in pulmonary vasoconstriction of the vessels perfusing non-ventilated alveolae. The systemic effects of inhaled nitric oxide, which include modulation of the distribution of systemic blood flow, increase in renal output, interaction with coagulation, fibrinolysis and platelet functions, alteration of the inflammatory response, are described and the mechanisms of nitric oxide transport are explained. The possible toxicity of inhaled nitric oxide is also discussed.C Co on nc cl lu us si io on n: : The multiple effects of inhaled nitric oxide support its role as a pulmonary and extra-pulmonary medication.

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A comparison of the acute hemodynamic effects of inhaled nitric oxide and aerosolized iloprost in primary pulmonary hypertension

Abstract: During acute drug testing, aerosolized iloprost was more potent than inhaled NO as a pulmonary vasodilator in PPH at the doses used in this study.

Cited by 290 publications

References 24 publications

Inhaled Iloprost for Severe Pulmonary Hypertension

Inhaled Iloprost for Severe Pulmonary Hypertension

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Inhaled nitric oxide in 2003: a review of its mechanisms of action

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