Neonatal ‘Pulmonary Vasodilator’ Drugs

Drummond, Willa H.; Lock, James E.

doi:10.1159/000457139

Cited by 21 publications

(6 citation statements)

References 77 publications

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“…12 In addition to optimizing lung volume, therapy directed at reducing pulmonary hypertension can consist of increasing pH, decreasing P aCO 2 , increasing P aO 2 and alveolar partial pressure of oxygen, and minimizing intrathoracic pressures. [13][14][15][16] Increasing pH has been shown to significantly reduce PVR in a variety of studies. 15,17,18 Both an increase in pH and a reduction in P aCO 2 can independently reduce right ventricular afterload.…”

Section: Effects Of Mechanical Ventilation On the Pulmonary Vasculaturementioning

confidence: 99%

“…[13][14][15][16] Increasing pH has been shown to significantly reduce PVR in a variety of studies. 15,17,18 Both an increase in pH and a reduction in P aCO 2 can independently reduce right ventricular afterload. In a classic report by Lyrene et al, 19 the effects of alkalosis on lowering PVR were similar regardless of whether the alkalosis was metabolic or respiratory in etiology.…”

Section: Effects Of Mechanical Ventilation On the Pulmonary Vasculaturementioning

confidence: 99%

“…15,16 Increasing the F IO 2 improves P aO 2 in patients without a right-to-left shunt and reduces pulmonary artery vascular resistance. Increasing inspired oxygen in patients with intracardiac shunts produces little change in P aO 2 ; however, a reduction in PVR still results.…”

Section: Effects Of Mechanical Ventilation On the Pulmonary Vasculaturementioning

confidence: 99%

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Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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The overall goal of the cardiorespiratory system is to provide the organs and tissues of the body with an adequate supply of oxygen in relation to oxygen consumption. An understanding of the complex physiologic interactions between the respiratory and cardiac systems is essential to optimal patient management. Alterations in intrathoracic pressure are transmitted to the heart and lungs and can dramatically alter cardiovascular performance, with significant differences existing between the physiologic response of the right and left ventricles to changes in intrathoracic pressure. In terms of cardiorespiratory interactions, the clinician should titrate the mean airway pressure to optimize the balance between mean lung volume (ie, arterial oxygenation) and ventricular function (ie, global cardiac output), minimize pulmonary vascular resistance, and routinely monitor cardiorespiratory parameters closely. Oxygen delivery to all organs and tissues of the body should be optimized, but not necessarily maximized. The heart and lungs are, obviously, connected anatomically but also physiologically in a complex relationship.

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Section: Effects Of Mechanical Ventilation On the Pulmonary Vasculaturementioning

confidence: 99%

Section: Effects Of Mechanical Ventilation On the Pulmonary Vasculaturementioning

confidence: 99%

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Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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“…Uma segunda fonte potencial de toxicidade com a administração de NO é a formação de metahemoglobina formando nitrosil-hemoglobina e finalmente metahemoglobina (HIBBS Jr.et al, 1988). O NO formado endogenamente bem como o NO administrado exogenamente é inativado por esse processo (DRUMMOND & LOCK, 1984). Devido ao fato da metahemoglobina perder sua capacidade de transportar oxigênio, elevada quantidade dessa substância podem potencialmente interferir com a distribuição de oxigênio nos tecidos.…”

Section: O óXido Nítrico E a Hipertensão Pulmonarunclassified

Utilização do óxido nítrico como terapêutica: implicações para a enfermagem

Santiago

Fernandes

Nogueira

et al. 2000

Rev. Latino-Am. Enfermagem

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INTRODUÇÃOUma das mais surpreendentes descobertas da última década foi a demonstração de que gases poluentes do meio ambiente, formado pela queima do nitrogênio, como óxido nítrico (NO) e monóxido de carbono (CO) são produzidos no organismo humano e funcionam como importantes sinalizadores biológicos. Tratando-se de uma molécula totalmente diferente das outras moléculas sinalizadoras, conhecidas, o NO já havia sido identificado em bactérias, entretanto, não era esperado que essa molécula pudesse ser encontrada em animais superiores.A descoberta da existência do NO endógeno foi fruto da realização de inúmeros estudos fisiológicos sobre a função normal da musculatura vascular lisa (IGNARRO, 1989). Esses estudos tiveram início com Furchgott e Zawadski em 1980, quando avaliavam os efeitos de drogas vasoativas sobre os vasos sangüíneos. Eles observavam que a mesma droga que algumas vezes produzia uma dilatação do vaso, outras vezes não apresentava o mesmo efeito. Eles sugeriram que essa variação pudesse ser dependente da integridade das células que circundavam o vaso sangüíneo. Em 1980, eles demonstraram, experimentalmente, que a acetilcolina dilata os vasos sangüíneos, somente se o endotélio estiver intacto (FURCHGOTT & ZAWADSKI, 1980). Assim, concluiram que os vasos sangüíneos se dilatam porque as células endoteliais produzem uma substância sinalizadora que faz a musculatura vascular lisa relaxar. Essa substância foi denominada então de fator relaxador derivado do endotélio (EDRF).Hoje sabe-se que o endotélio regula o tônus vascular através da produção de diversos mediadores, como prostaglandinas e endotelina, os quais agem na musculatura vascular lisa, além do EDRF (CLARK & GOLLAN, 1966). Essas substâncias atuam como sinalizadores intracelulares entre o endotélio e a musculatura vascular lisa modulando a vasoconstrição ou a vasodilatação (IGNARRO et al., 1987).A composição precisa do EDRF era de início * Discente do 5º Semestre do curso

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“…However, none of these drugs is specific for the pulmonary vas cular smooth muscle and all of them also cause systemic vascular relax ation [Drummond and Lock, 1984;Tripp et al, 1980], Tolazoline, beside its systemic hypotensive action, may have severe adverse effects, mainly acute renal failure [Trompeter et al, 1981] and myocardium toxicity [Segali and Lewenstein, 1953].…”

Section: Pulmonary Hypertension May Occur In the Newborn Infant In A mentioning

confidence: 99%

Effects of Tolazoline on Regional Blood Flows in the Newborn Piglet

Clozel¹,

Jm²,

Monin³

et al. 1987

Dev Pharmacol Ther

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To assess the effects of intravenous tolazoline on hemodynamics and regional blood flow distribution, 12 anesthetized newborn piglets were studied. Six piglets received saline and served as controls, the other 6 received two bolus doses of tolazoline (1 and 2 mg/kg). Mean arterial blood pressure decreased from control levels of 69.4 ± 5.6 to 54.6 ± 7.0 and 47.0 ± 5.6 mm Hg, respectively, after 1 and 2 mg/kg of tolazoline, and heart rate increased from 220 ± 9 to 270 ± 13 and 282 ± 8 beats/min, respectively. Cardiac output and regional blood flows were measured 15 min after tolazoline by the radioactive microsphere technique. Cardiac index did not change significantly. There was a redistribution of cardiac output toward the coronary circulation, with an increase in coronary blood flow from a control value of 249.3 ± 39.9to 361.0 ± 56.4 ml/min/100 g of tissue after 1 mg/kg of tolazoline. Bronchial blood flow was also significantly increased. After a dose of 2 but not 1 mg/kg, the renal blood flow was markedly decreased from 139.8 ± 17.8 to 104.4 ± 24.5 ml/min/100g. The other regional blood flows were not significantly modified. We conclude that tolazoline is a potent coronary vasodilator during the neonatal period. In addition we speculate that the decrease in renal blood flow might play a role in the renal toxicity of tolazoline.

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Neonatal ‘Pulmonary Vasodilator’ Drugs

Cited by 21 publications

References 77 publications

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Utilização do óxido nítrico como terapêutica: implicações para a enfermagem

Effects of Tolazoline on Regional Blood Flows in the Newborn Piglet

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