Clinical Indication for Use and Outcomes After Inhaled Nitric Oxide Therapy

George, Isaac; Xydas, Steve; Topkara, V.K.; Ferdinando, C. H.; Barnwell, Eileen C.; Gableman, Larissa; Sladen, Robert N.; Naka, Yoshifumi; Öz, Mehmet C.

doi:10.1016/j.athoracsur.2006.06.081

Cited by 76 publications

(43 citation statements)

References 33 publications

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“…In addition, it will be important to compare the effects of inhaled NO, which has been demonstrated to mitigate lung I/R injury (33)(34)(35)(36), with the effects of hydrogen. Although some transplant centers have demonstrated detrimental or marginal effects of NO (37)(38)(39), NO is involved in the maintenance of physiologic homeostasis and can be protective. Because hydrogen does not alter the activities of NO and spares endogenous NO (8), approaches using combined gas therapy using hydrogen and NO to prevent lung I/R might be feasible (40).…”

Section: Discussionmentioning

confidence: 99%

Inhaled Hydrogen Gas Therapy for Prevention of Lung Transplant-Induced Ischemia/Reperfusion Injury in Rats

Kawamura¹,

Huang²,

Lee³

et al. 2010

Transplantation Journal

102

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Background. Successful abrogation of ischemia/reperfusion (I/R) injury of lung grafts could significantly improve short-and long-term outcomes for lung transplant (LTx) recipients. Hydrogen gas has potent antioxidant and antiapoptotic properties and has been recently used in number of experimental and clinical studies. The purpose of this research was to investigate whether inhaled hydrogen gas could reduce graft I/R injury during lung transplantation. Methods. Orthotopic left LTxs were performed in syngenic Lewis rats. Grafts were perfused with and stored in low potassium dextran solution at 4°C for 6 hr. The recipients received 100% O 2 or 98% O 2 with 2% N 2 , 2% He, or 2% H 2 during surgery and 1 hr after reperfusion. The effects of hydrogen were assessed by functional, pathologic, and molecular analysis. Results. Gas exchange was markedly impaired in animals exposed to 100% O 2 , 2% N 2 , or 2% He. Hydrogen inhalation attenuated graft injury as indicated by significantly improved gas exchange 2 hr after reperfusion. Graft lipid peroxidation was significantly reduced in the presence of hydrogen, demonstrating antioxidant effects of hydrogen in the transplanted lungs. Lung cold I/R injury causes the rapid production and release of several proinflammatory mediators and epithelial apoptosis. Exposure to 2% H 2 significantly blocked the production of several proinflammatory mediators and reduced apoptosis with induction of the antiapoptotic molecules B-cell lymphoma-2 and B-cell lymphoma-extra large. Conclusion. Treatment of LTx recipients with inhaled hydrogen can prevent lung I/R injury and significantly improve the function of lung grafts after extended cold preservation, transplant, and reperfusion.

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Section: Discussionmentioning

confidence: 99%

Inhaled Hydrogen Gas Therapy for Prevention of Lung Transplant-Induced Ischemia/Reperfusion Injury in Rats

Kawamura¹,

Huang²,

Lee³

et al. 2010

Transplantation Journal

102

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“…In 26 ICU patients with acute RVF, 14 patients experienced significant increases in CO and oxygenation as well as decreases in PVR with iNO (35 ppm) (72). iNO use for PH and/or RVF in patients undergoing orthotopic heart or lung transplantation was associated with lower mortality compared with its use in cardiac surgery or medical patients with hypoxemia (73). Improvements in PVR and RV dysfunction were confirmed in another study of heart transplant recipients (74) and in patients with PH after mitral valve replacement (75).…”

mentioning

confidence: 95%

Medical and Surgical Treatment of Acute Right Ventricular Failure

Lahm

McCaslin

Wozniak

et al. 2010

Journal of the American College of Cardiology

166

138

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Acute right ventricular (RV) failure is a frequent and serious clinical challenge in the intensive care unit. It is usually seen as a consequence of left ventricular failure, pulmonary embolism, pulmonary hypertension, sepsis, acute lung injury or after cardiothoracic surgery. The presence of acute RV failure not only carries substantial morbidity and mortality, but also complicates the use of commonly used treatment strategies in critically ill patients. In contrast to the left ventricle, the RV remains relatively understudied, and investigations of the treatment of isolated RV failure are rare and usually limited to nonrandomized observations. We searched PubMed for papers in the English language by using the search words right ventricle, right ventricular failure, pulmonary hypertension, sepsis, shock, acute lung injury, cardiothoracic surgery, mechanical ventilation, vasopressors, inotropes, and pulmonary vasodilators. These were used in various combinations. We read the abstracts of the relevant titles to confirm their relevance, and the full papers were then extracted. References from extracted papers were checked for any additional relevant papers. This review summarizes the general measures, ventilation strategies, vasoactive substances, and surgical as well as mechanical approaches that are currently used or actively investigated in the treatment of the acutely failing RV.

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“…71,86 iNO therapy seems to have a short-term benefit in patients with acute right heart failure secondary to PH but does not seem to provide an overall mortality benefit other than for patients with acute postoperative PH. 87,88 Abrupt discontinuation of iNO therapy can result in rebound PH and, therefore, should be avoided. Prolonged iNO therapy has also been associated with methemoglobinemia, so it is recommended that serum concentrations should be determined before initiation of therapy and monitored every 6 hours during treatment.…”

Section: Nitric Oxidementioning

confidence: 99%