Abstract 16196: Nitric Oxide Delivery During Cardiopulmonary Bypass Reduces Acute Kidney Injury: Randomized Trial

Abstract

Introduction: Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). Postoperative AKI develops in 30% to 52% of cardiac surgery patients and 2% to 5% of these patients require renal replacement therapy. Hypothesis: We hypothesized that nitric oxide treatment during cardiac surgery with CPB can decrease AKI incidence in adult patients. The aim of study was to evaluate the effects of nitric oxide supplementation to CPB circuit on the development of cardiac surgery-associated AKI. Methods: A prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at www.clinicaltrials.gov (#NCT03527381). Patients were randomly assigned to either the nitric oxide supplementation to CPB circuit (NO-treatment group, n = 48) or the usual care (control group, n = 48). 40-ppm nitric oxide was administered in NO-treatment group during the entire CPB period. The primary outcome was AKI incidence. Results: Nitric oxide treatment was associated with a significant decrease in AKI incidence (10 (20.8%) versus 20 (41.6%); RR 0.5 (95% CI 0.26-0.95; p =0.023) and a higher urine output during CPB (2.6 [2.1;5.08] versus 1.7 [0.80;2.50] mL/kg/h; p = 0.0002). Urinary neutrophil gelatinase-associated lipocalin levels were significantly lower in NO-treatment group 4 h after surgery: 1.12 [0.75;5.8] versus 4.62 [2.02;34.55] ng/mL; p = 0.005. Concentrations of nitric oxide metabolites in NO-treatment group significantly increased at 5 min post-clamping, 5 min after declamping, and at the end of surgery. The concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not significantly differ between groups. Conclusions: Nitric oxide administration to patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a decrease in AKI incidence. The implications of study for clinical practice expand the array of methods, which may be used for prevention of AKI in cardiac surgery patients.

Inhalation therapy with high doses of nitric oxide in a comorbid patient with COVID-19: A clinical case

“…5. Спиральная компьютерная томография органов грудной клетки на 10-е сутки заболевания, отрицательная динамика, увеличение площади поражения легочной паренхимы до 76% Возможные благоприятные системные эффекты лечения ингаляционного NO включают антиагрегантный, лейкоцитарный антиадгезивный и противовоспалительный эффекты, которые потенциально могут предотвратить цитокиновый шторм и снизить риск внелегочных органных осложнений [15][16][17]. Более того, наличие резервного пула NO во внелегочных тканях за счет механизма S-нитрозилирования приводит к снижению тонуса сосудов, снижению риска тромбообразования и адгезии лейкоцитов к системному эндотелию сосудов [18].…”