Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients.

Beghetti, Maurice; Habre, Walid; Friedli, Béat; Berner, Michel

doi:10.1136/hrt.73.1.65

Cited by 111 publications

(52 citation statements)

References 15 publications

(14 reference statements)

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“…Özellikle erken postoperatif dönemde tedaviye yanıt alınamayan pulmoner hipertansiyonda inhalasyon yoluyla NO ve iloprost kullanımının güvenilir-liği ve pulmoner basıncı düşürmede etkinliği gösterilmiştir [7]. Kardiyopulmoner baypas (KPB) kandaki pulmoner vazokonstriktör maddelerin artışına neden olmaktadır [8]. Erken postoperatif dönemde hem KPB'ın etkisi ile artmış pulmoner vazokonstriktör maddelerin varlığı ve hem de ventilasyon perfüzyon uyumsuzluğu sonucu oluşan alveolar hipoksiye sekonder pulmoner hiper- tansif kriz daha sık görülmektedir [9][10][11][12].…”

Section: Discussionunclassified

Surgical Outcome of Total Anomalous Pulmonary Venous Return; Single Center Experience

Kırbaş¹,

Yalçın²,

Tanrikulu³

et al. 2013

Ann Clin Anal Med

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Section: Discussionunclassified

Surgical Outcome of Total Anomalous Pulmonary Venous Return; Single Center Experience

Kırbaş¹,

Yalçın²,

Tanrikulu³

et al. 2013

Ann Clin Anal Med

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“…These include currently approved clinical treatments, such as NO inhalation 22,23 and PDE5 inhibitors, 24,25 and more recently soluble gyuanylate cyclase stimulators. Our data from the isolated perfused lungs demonstrate a direct effect of exogenous BH 4 administration on pulmonary NO production during hypoxic ventilation, leading to acute vasorelaxation during the plateau phase of hypoxia-induced pulmonary vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

Effects of Tetrahydrobiopterin Oral Treatment in Hypoxia‐Induced Pulmonary Hypertension in Rat

et al. 2014

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Endothelial nitric oxide synthase (eNOS) plays a major role in maintaining pulmonary vascular homeostasis. Tetrahydrobiopterin (BH 4 ), an essential cofactor that stabilizes the dimerization of eNOS and balances nitric oxide (NO) and superoxide production, may have therapeutic potential in pulmonary hypertension. In the isolated perfused lung, we demonstrated a direct effect of exogenous administration of BH 4 on pulmonary NO production, leading to acute vasorelaxation during the plateau phase of hypoxia-induced pulmonary vasoconstriction. In the chronic hypoxia-induced pulmonary hypertension rat model, chronic BH 4 oral administration attenuated the pressor response to hypoxia (mean pulmonary artery pressure AE standard error of the mean, 31.8 AE 0.5 mmHg at 100 mg/kg/day; placebo group, 36.3 AE 0.6 mmHg; P < 0.05). During telemetric monitoring, right ventricular systolic pressure was reduced by approximately 50% after 1 week of BH 4 treatment at 100 mg/kg/day. BH 4 at 100 mg/kg/day reduced right ventricular hypertrophy (from 0.55 AE 0.01 to 0.50 AE 0.01; P < 0.05) and pulmonary vascular muscularization (from 79.2% AE 2% to 65.2% AE 3%; P < 0.01). BH 4 treatment enhanced lung eNOS activity and reduced superoxide production, with a net increase in cyclic guanosine monophosphate levels. BH 4 is effective in attenuating pulmonary hypertension in the hypoxic rat model when given as a rescue therapy.

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“…iNO therapy in pediatric patients after surgery for congenital heart disease has been reported in a variety of clinical trials, including case reports, pilot studies, prospective and retrospective investigations, randomized controlled clinical studies, and crossover studies. 3,[7][8][9][10][11][12][13][14][15][16][17][18] The recommended dose of iNO is 20 ppm for the approved indication of hypoxic respiratory failure associated with pulmonary hypertension in term and near-term neonates. 3,19 iNO may also be beneficial in patients with right ventricular dysfunction because it selectively decreases right ventricular afterload and improves right ventricular function.…”

Section: Discussionmentioning

confidence: 99%

Reducing Variation in the Use of Inhaled Nitric Oxide

Simsic¹,

Harrison

Evans

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Decreasing practice variation and following clinical guidelines improve patient outcomes and reduce costs. Inhaled nitric oxide (iNO) is an effective but expensive treatment of pulmonary hypertension and right heart failure in patients with congenital or acquired heart disease. Our objective was to implement standardized initiation and weaning guidelines for iNO usage in the cardiothoracic ICU (CTICU) to reduce variation in use while maintaining quality patient care. METHODS: All CTICU patients who received iNO from January 2011 to December 2012 were retrospectively reviewed. Standardized iNO initiation and weaning guidelines were implemented in January 2012. Variables before and after guideline implementation were compared. RESULTS: From January to December 2011, there were 36 separate iNO events (6% of CTICU admissions; n = 547). Mean ± SD iNO usage per event was 159 ± 177 hours (median: 63 hours; range: 27–661 hours). From January to December 2012, there were 47 separate iNO events (8% of CTICU admissions; n = 554). Mean iNO usage per event was 125 ± 134 hours (median: 72 hours; range: 2–557 hours). Initiation guideline compliance improved from 83% to 86% (P = .9); weaning guideline compliance improved from 17% to 79% (P < .001). Although mean iNO usage per event decreased, there was no significant reduction in utilization of iNO (P = .09). CONCLUSIONS: Implementation of standardized iNO initiation and weaning guidelines in the CTICU was successful in reducing practice variation supported by increasing guideline compliance. However, decreasing practice variation did not significantly reduce iNO utilization and does not necessarily reduce cost.

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Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients.

Abstract: Inhalation of NO reduced pulmonary artery pressure in children with severe pulmonary hypertension after cardiac surgery and this effect was maintained over several days at concentrations carrying little risk of toxicity.

Cited by 111 publications

References 15 publications

Surgical Outcome of Total Anomalous Pulmonary Venous Return; Single Center Experience

Surgical Outcome of Total Anomalous Pulmonary Venous Return; Single Center Experience

Effects of Tetrahydrobiopterin Oral Treatment in Hypoxia‐Induced Pulmonary Hypertension in Rat

Reducing Variation in the Use of Inhaled Nitric Oxide

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