Inhaled nitric oxide in cardiac surgery: Evidence or tradition?

Benedetto, Maria; Romano, Rosalba; Baca, Georgiana Luisa; Sarridou, Despoina; Fischer, Andréas; Simón, A.; Marczin, Nándor

doi:10.1016/j.niox.2015.06.002

Cited by 32 publications

(22 citation statements)

References 105 publications

(85 reference statements)

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“…However, iNO did not significantly reduce the incidence of RV failure in a multicentre randomized study [237]. Expert panels concluded that it is reasonable to consider using iNO during LVAD implantation [238, 239].…”

Section: Anaesthetic Managementmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

279

446

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Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many—sometimes contradictory—observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

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Section: Anaesthetic Managementmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

279

446

View full text Add to dashboard Cite

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“…Recently, Benedetto et al . described the potential benefits of iNO in lung‐transplanted patients and defined iNO as a “master reperfusion anesthetic”. This refers to its multiple effects, including selective pulmonary vasodilation , better management of reperfusion , optimization of the ventilation‐perfusion ratio, protection from inflammatory insults in the allograft and the inhibition of ischemic reperfusion injury‐induced apoptosis .…”

Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide dependency at the end of double-lung transplantation: a boosted propensity score cohort analysis

et al. 2018

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Summary Inhaled nitric oxide (iNO) is usually used during lung transplantation despite controversial postoperative benefits. Our group chose to administer iNO systematically during the procedure and stop at the end of surgery. This study aims to describe the features of patients who cannot be weaned from iNO, the reasons for this and its impact on postoperative outcomes. This is a monocentric cohort study comprised all consecutive patients who underwent double‐lung transplantation (DLT) between 1 January 2012 and 1 January 2016. The impact of iNO dependency on postoperative outcomes was estimated using a boosted inverse probability of treatment weighting estimator. A total of 9.8% of the 173 patients included in the study could not be weaned from iNO at end‐surgery stage. Body mass index (OR = 2.03, 95% CI = 1.14–3.29, P = 0.02) and intraoperative extracorporeal membrane oxygenation (OR = 1.80, 95% CI = 1.02–2.72, P = 0.04) were risk factors for iNO dependency In the weighted population, iNO dependency was associated with an increased prevalence of grade 3 primary graft dysfunction (adjusted RR = 4.20, 95% CI = 1.75–10.09, P < 0.001) and decreased postoperative survival during the first 1500 days of follow‐up (adjusted HR = 5.0, 95% CI = 1.86–13.48, P < 0.001). Inhaled nitric oxide dependency is an early marker of a poor prognosis following DLT.

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“…Furthermore, iNO was reported to have a kidney-protective effect by decreasing the incidence of acute kidney injury (49)(50)(51). However, the clinical outcomes of iNO were of no or minimal benefit; large randomized trials are needed to assess its effect on major clinical outcomes and its costeffectiveness (52,53). iNO also has been used to treat PH and hypoxemia that occurs in thoracic surgery during onelung ventilation, postpneumonectomy pulmonary edema, and lung transplantation (54,55).…”

Section: Cardiothoracic Surgerymentioning

confidence: 99%

Inhaled pulmonary vasodilators: a narrative review

Li¹,

Wang²,

Yu³

et al. 2021

Ann Transl Med

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Pulmonary hypertension (PH) is a severe disease that affects people of all ages. It can occur as an idiopathic disorder at birth or as part of a variety of cardiovascular and pulmonary disorders. Inhaled pulmonary vasodilators (IPV) can reduce pulmonary vascular resistance (PVR) and improve RV function with minimal systemic effects. IPV includes inhaled nitric oxide (iNO), inhaled aerosolized prostacyclin, or analogs, including epoprostenol, iloprost, treprostinil, and other vasodilators. In addition to pulmonary vasodilating effects, IPV can also be used to improve oxygenation, reduce inflammation, and protect cell.Off-label use of IPV is common in daily clinical practice. However, evidence supporting the inhalational administration of these medications is limited, inconclusive, and controversial regarding their safety and efficacy. We conducted a search for relevant papers published up to May 2020 in four databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical using and updated evidence of IPV. iNO is widely used in neonates, pediatrics, and adults with different cardiopulmonary diseases. The limitations of iNO include high cost, flat dose-response, risk of significant rebound PH after withdrawal, and the requirement of complex technology for monitoring. The literature suggests that inhaled aerosolized epoprostenol, iloprost, treprostinil and others such as milrinone and levosimendan may be similar to iNO. More research of IPV is needed to determine acceptable inclusion criteria, long-term outcomes, and management strategies including time, dose, and duration.

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Inhaled nitric oxide in cardiac surgery: Evidence or tradition?

Cited by 32 publications

References 105 publications

2019 EACTS Expert Consensus on long-term mechanical circulatory support

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Inhaled nitric oxide dependency at the end of double-lung transplantation: a boosted propensity score cohort analysis

Inhaled pulmonary vasodilators: a narrative review

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