Small-Dose Inhaled Nitric Oxide Attenuates Hemodynamic Changes After Pulmonary Air Embolism in Dogs

Tanus‐Santos, José Eduardo; Moreno, Heitor; Zappellini, A.; Nucci, Gilberto De

doi:10.1213/00000539-199905000-00010

Cited by 29 publications

(10 citation statements)

References 27 publications

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“…In this study, we demonstrate that inhalation of 40 ppm NO causes selective pulmonary vasodilation in animals with sustained pulmonary hypertension due to recurrent pulmonary microembolism. This is consistent with our previous data obtained in the same model (19) and with data from studies in acute pulmonary embolism in animal models (9–14) and in patients (15, 16).…”

Section: Discussionsupporting

confidence: 93%

“…This study provides evidence that both O 2 and iNO are selective pulmonary vasodilators in a porcine model of sustained pulmonary hypertension following recurrent pulmonary microembolism. Extending data from the literature in acute experimental pulmonary embolism (9–16), our results suggest that NO inhalation may also be useful in the treatment of pulmonary hypertension later in the time course of the disease. Therefore, we believe that clinical studies regarding effectiveness and safety of inhaled nitric oxide for the treatment of patients with pulmonary embolism are warranted.…”

Section: Discussionsupporting

confidence: 65%

“…Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator in patients with the acute respiratory distress syndrome (ARDS), neonates with persistent pulmonary hypertension, and in patients after cardiac surgery (for review see reference 8). Data obtained in animal models of acute PE (9–14) and case reports in humans (15, 16) have suggested a beneficial role of iNO in the treatment of acute PE.…”

mentioning

confidence: 99%

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Effects of oxygen and nitric oxide inhalation in a porcine model of recurrent microembolism

Weimann¹,

Zink²,

Gebhard³

et al. 2000

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 65%

mentioning

confidence: 99%

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Effects of oxygen and nitric oxide inhalation in a porcine model of recurrent microembolism

Weimann¹,

Zink²,

Gebhard³

et al. 2000

Acta Anaesthesiol Scand

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“…The understanding that acute pulmonary embolism‐induced pulmonary hypertension results from interactions of multiple mechanisms, including active pulmonary vasoconstriction, has motivated some investigators to study new pharmacological interventions that could attenuate the haemodynamic changes associated with this condition [3,4]. Particularly, reversing the pulmonary vasoconstrictor response by activating the nitric oxide–cyclic guanosine 3′,5′‐monophosphate (cGMP) pathway has been shown to improve haemodynamics in different animal models of pulmonary embolism [5–14]. However, few studies have addressed the hypothesis that the combination of drugs that produce beneficial effects can increase the effects produced by each drug alone.…”

mentioning

confidence: 99%

Sildenafil Improves the Beneficial Haemodynamic Effects of Intravenous Nitrite Infusion during Acute Pulmonary Embolism

Dias‐Junior

Montenegro

Florencio

et al. 2008

Basic Clin Pharma Tox

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Acute pulmonary embolism produces acute pulmonary hypertension, which can be counteracted by activating the nitric oxide-cyclic guanosine 3 ′ ,5 ′ -monophosphate (cGMP) pathway. While previous studies have shown that sildenafil (an inhibitor of cGMP-specific phosphodiesterase type 5) or nitrite (a storage molecule for nitric oxide) produces beneficial effects during acute pulmonary embolism, no previous study has examined whether the combination of these drugs can produce additive effects. Here, we expand previous findings and examine whether sildenafil enhances the beneficial haemodynamic effects produced by a low-dose infusion of nitrite in a dog model of acute pulmonary embolism. Haemodynamic and arterial blood gas evaluations were performed in non-embolized dogs treated with saline (n = 4), and in embolized dogs (intravenous injections of microspheres) that received nitrite (6.75 μ mol/kg intravenously over 15 min. followed by 0.28 μ mol/kg/min.) and sildenafil (0.25 mg/kg over 30 min.; n = 8), or nitrite followed by saline (n = 8), or saline followed by sildenafil (n = 7), or only saline (n = 8). Plasma thiobarbituric acid-reactive substances (TBARS) concentrations were determined using a fluorometric method. Acute pulmonary embolism increased pulmonary artery pressure by ∼ 24 mmHg. While the infusion of nitrite or sildenafil infusions reversed this increase by ∼ 42% (both P < 0.05), the combined infusion of both drugs reversed this increase by ∼ 58% (P < 0.05). Similar effects were seen on the pulmonary vascular resistance index. Nitrite or sildenafil alone produced no significant hypotension. However, the combined infusion of both drugs caused transient hypotension (P < 0.05). Both dugs, either alone or combined, blunted the increase in TBARS concentrations caused by acute pulmonary embolism (all P < 0.05). These results suggest that sildenafil improves the beneficial haemodynamic effects of nitrite during acute pulmonary embolism.Acute pulmonary embolism is a serious complication resulting from the migration of embolus to the lungs and obstruction of pulmonary vessels. This critical condition is a leading cause of death [1], which results from acute right heart failure and circulatory shock [2]. The understanding that acute pulmonary embolism-induced pulmonary hypertension results from interactions of multiple mechanisms, including active pulmonary vasoconstriction, has motivated some investigators to study new pharmacological interventions that could attenuate the haemodynamic changes associated with this condition [3,4]. Particularly, reversing the pulmonary vasoconstrictor response by activating the nitric oxide-cyclic guanosine 3 ′ ,5 ′ -monophosphate (cGMP) pathway has been shown to improve haemodynamics in different animal models of pulmonary embolism [5][6][7][8][9][10][11][12][13][14]. However, few studies have addressed the hypothesis that the combination of drugs that produce beneficial effects can increase the effects produced by each drug alone.We were first to show that sildenafil ...

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“…Outro vasodilatador é o óxido nítrico (NO), o qual, administrado por via inalatória, produziu dilatação seletiva dos vasos pulmonares em condições de hipertensão arterial pulmonar induzida experimentalmente (Bottiger et al 1996;Tanus-Santos et al 1999a;Tanus-Santos et al 1999b;Tanus-Santos et al 2002;Weimann et al 1999).…”

Section: Vasoconstrição Pulmonar Mediada Por Fatores Humoraisunclassified

Alterações das concentrações plasmáticas de troponina I e de metaloproteinases 2 e 9 da matriz extracelular após embolia aguda em cães

Uzuelli¹

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meu marido Ricardo, pela compreensão, carinho, presença e incansável apoio ao longo da execução deste trabalho. Ao meu querido avô materno, Altino Idelfonso Alves, que sempre acreditou na minha força de vontade em alcançar os meus objetivos. Meus sinceros agradecimentos, A Deus, pois me concedeu saúde, paciência e persistência para que eu pudesse finalizar esta importante etapa da minha vida. A minha família por acreditar na minha dedicação aos estudos e sempre me ajudar no que fosse necessário para que este momento se realizasse. Sem a base sólida de meus pais, em especial o meu pai, eu não seria capaz de cumprir mais esta etapa na minha vida. Ao meu marido Ricardo pela compreensão nos momentos difíceis, sempre pronto para me ajudar a resolver os mais diversos problemas. Sem a sua fé e amor incondicionais, talvez eu não tivesse vencido várias barreiras. Ao Prof. Dr. José Eduardo Tanus dos Santos, pela orientação, amizade e paciência dedicada a estes anos de trabalho. Seus ensinamentos contribuíram para meu crescimento científico, intelectual e ético. Aos membros da minha banca, Prof. Dr. Baddini e Prof. Dr. Sérgio Line por aceitarem o convite para participar e contribuir para minha formação. A CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) pelo apoio financeiro durante o mestrado. A todos meus amigos do laboratório, que em algum momento conviveu comigo, seja na execução de um trabalho ou no gesto de um simples bom dia, muito obrigado pela amizade. Posso dizer, com certeza, que eles formam a minha segunda família. Com eles, é possível trabalhar com responsabilidade, sem perder o humor! A amiga Vânia, pelos conselhos e força nos momentos difíceis da pós-graduação. A amiga Caroline, pelas lições de empenho em realizar um objetivo, pela maturidade nos estudos e na vida e pela ajuda em vários trabalhos. Ao amigo Carlos, grande ser humano e meu braço direito. Sem ele, não seria possível este acontecimento. Aos professores deste Departamento pelos ensinamentos e contribuição com a minha formação acadêmica. Ao Prof. Milton César Foss e seu funcionário Sebastião pela colaboração nas pesquisas. Aos secretários, Sônia, Ramon e Fátima, pela disponibilidade e ajuda na execução dos tramites administrativos e financeiros da Pós-graduação. Aos funcionários do Biotério Central pelo cuidado e fornecimento dos nossos animais.ix pró-MMP-9 aumenta em 80% apenas no grupo que recebeu 5 mL/Kg de coágulos.A TI cardíaca no soro e a atividade da pró-MMP-9 no plasma tiveram uma correlação positiva com o índice de resistência vascular pulmonar (p=0,007 e rs=0,833 para a TI, e p=0,034 e rs=0,684 para a pró-MMP-9) e com a pressão média na artéria pulmonar (p=0,005 e rs=0,610 para a TI, e p=0,022 e rs=0,720 para a pró-MMP-9). Concluímos que a TI cardíaca e a pró-MMP-9 circulantes aumentam em proporção à gravidade da EPA, embora o aumento da pró-MMP-9 não seja muito evidente em graus menos severos da EPA. Estes achados podem ser relevantes para a clínica da EPA. ABSTRACTSeverity dependent increases in circulating cardiac tr...

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Small-Dose Inhaled Nitric Oxide Attenuates Hemodynamic Changes After Pulmonary Air Embolism in Dogs

Cited by 29 publications

References 27 publications

Effects of oxygen and nitric oxide inhalation in a porcine model of recurrent microembolism

Effects of oxygen and nitric oxide inhalation in a porcine model of recurrent microembolism

Sildenafil Improves the Beneficial Haemodynamic Effects of Intravenous Nitrite Infusion during Acute Pulmonary Embolism

Alterações das concentrações plasmáticas de troponina I e de metaloproteinases 2 e 9 da matriz extracelular após embolia aguda em cães

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