The Effects of Inhaled Nitric Oxide and Its Combination with Intravenous Almitrine on PaO2 During One-Lung Ventilation in Patients Undergoing Thoracoscopic Procedures

Moutafis, M.; Liu, Ngai; Dalibon, Nicolas; Kuhlman, G; Ducros, Laurent; Castelain, M.H.; Fischler, Marc

doi:10.1213/00000539-199711000-00032

Cited by 52 publications

(10 citation statements)

References 18 publications

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“…The calculation of the required sample size was based on the lowest Pa O 2 measured during OLV under propofol anaesthesia in a previous study [16.5 (7.3) kPa] 12 and on the experimental HPV inhibition by sevoflurane leading to an increase of 9% of shunt fraction 1 2 which corresponds theoretically to a Pa O 2 decrease of 5.3 kPa during FI O 2 1 ventilation. 13 Thirty-one patients per group were required in order to detect a difference of 5.3 kPa in the lowest Pa O 2 between groups and we decided to enrol 40 patients per group.…”

Section: Methodsmentioning

confidence: 99%

Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation

Pruszkowski

Dalibon

Moutafis

et al. 2007

British Journal of Anaesthesia

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Background. The inhibitory effect of anaesthetic agents on hypoxic pulmonary vasoconstriction may depend upon their dose, especially when using a volatile agent. The aim of this randomized open study was to compare the effects of sevoflurane and propofol, as primary anaesthetic agents, on oxygenation during one-lung ventilation (OLV), with their administration being adjusted to maintain bispectral index (BIS) values between 40 and 60.

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Section: Methodsmentioning

confidence: 99%

Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation

Pruszkowski

Dalibon

Moutafis

et al. 2007

British Journal of Anaesthesia

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“…This effect is limited to the ventilated regions of the lung, thus improving the perfusion of ventilated regions, causing a reduction in intrapulmonary shunting and improving arterial oxygenation. The improvement in oxygenation with the combination of inhaled NO and almitrine bismesylate has been shown in ARDS patients [17±19], in hypoxaemic patients with focal lung lesions [20] and during one-lung ventilation in patients undergoing thoracic procedures [21]. The enhancement of hypoxic pulmonary vasoconstriction by almitrine bismesylate is also strongly suggested by the decrease in blood flow to low V'/Q' hypoxic lung regions demonstrated in mechanically ventilated COPD patients [22].…”

Section: Influence Of Noradrenalin On the Oxygenation Effects Of Inhamentioning

confidence: 96%

Inhaled NO and almitrine bismesylate in patients with acute respiratory distress syndrome: effect of noradrenalin

Papazian

Gaillat²,

Thirion³

et al. 1999

Eur Respir J

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Inhaled NO and almitrine bismesylate in patients with acute respiratory distress syndrome: effect of noradrenalin. L. Papazian, F. Bregeon, F. Gaillat, X. Thirion, A. Roch, E. Cortes, V. Fulachier, P. Saux, Y. Jammes, J-P. Auffray. #ERS Journals Ltd 1999. ABSTRACT: The combination of inhaled nitric oxide with almitrine bismesylate has been proposed for the management of acute respiratory distress syndrome in order to divert pulmonary blood flow away from poorly ventilated toward well-ventilated areas. The aims of this prospective and comparative study were to: 1) confirm the beneficial effects on oxygenation of this association; 2) evaluate the haemodynamic effects of this association; and 3) evaluate the influence of noradrenaline (a nonspecific vasoconstrictor) on the modification of gas exchange related to inhaled NO and/or almitrine bismesylate.Forty-one sedated paralysed and ventilated patients were investigated. Haemodynamic and blood gas measurements were performed in a fixed order: baseline; inhalation of NO for 30 min.; intravenous infusion of almitrine bismesylate; and concomitant administration of inhaled NO and almitrine bismesylate.Inhaled NO and almitrine bismesylate increased arterial oxygen tension (Pa,O 2 )/ inspiratory oxygen fraction (FI,O 2 ) (p<0.001). The association of inhaled NO with almitrine bismesylate resulted in a dramatic improvement in Pa,O 2 /FI,O 2 (p<0.0001 versus almitrine bismesylate, p<0.05 versus inhaled NO). In patients receiving noradrenalin (n=19), almitrine bismesylate had no effect on oxygenation.The present study confirmed that the combination of inhaled NO with almitrine bismesylate improved oxygenation, and demonstrated that almitrine bismesylate has no effect on oxygenation in patients receiving noradrenalin. Eur Respir J 1999; 14: 1283±1289. Despite the use of new therapeutic agents, acute respiratory distress syndrome (ARDS)-related mortality remains high [1,2]. Inhaled nitric oxide has been widely used since the beginning of the 1990s but recent studies have been unable to demonstrate a significant decrease in mortality related to its use [3,4]. Certain methodological considerations could possibly explain, in part, this lack of positive impact on outcome. However, it could be useful to find some therapeutic associations that would enhance the beneficial effects of inhaled NO on oxygenation. It has been found that the association of the prone position with inhaled NO can enhance arterial oxygen tension Pa,O 2 [5]. A pharmacological approach consisting of diverting pulmonary blood flow away from poorly-ventilated toward well-ventilated areas in which inhaled NO can exert its vasodilating action would appear to be attractive. Several vasoactive agents have been proposed, i.e. the use of a systemic and pulmonary vasoconstrictor (phenylephrine) [6] or the use of a specific pulmonary vasoconstrictor (almitrine bismesylate) [7,8]. Noradrenalin (NA) is extensively used in the intensive care unit (ICU) [9], especially in septic shock, which is frequently associated with A...

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“…In this case, vasodilation in ventilated lung probably increased P a O 2 by "stealing" perfusion from the shunt region, which was not exposed to the inhaled NO. In contrast, inhaled NO did not improve gas exchange in dogs with right lower lobar atelectasis (1188) or patients receiving one-lung ventilation during thoracic surgery (388, 547, 1333,2106). This lack of effect suggests that 1) pulmonary vasomotor tone in ventilated regions was minimal in normal lungs and therefore not influenced by inhaled NO; 2) NO-dependent diversion of perfusion from unventilated to ventilated lung lowered V A /Q ratios in ventilated lung sufficiently to prevent improvement in P a O 2 despite a reduced shunt fraction; or 3) HPV in the shunt region was inhibited by anesthetics or recirculation of inhaled NO to the shunt region as nitrite or S-nitrosothiol proteins in blood (406, 592,612,1144).…”

Section: Iv) Regional Shunt or Hypoventilation In Normal Lungsmentioning

confidence: 98%

Hypoxic Pulmonary Vasoconstriction

Sylvester

Shimoda

Aaronson

et al. 2012

Physiological Reviews

599

621

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It has been known for more than 60 years, and suspected for over 100, that alveolar hypoxia causes pulmonary vasoconstriction by means of mechanisms local to the lung. For the last 20 years, it has been clear that the essential sensor, transduction, and effector mechanisms responsible for hypoxic pulmonary vasoconstriction (HPV) reside in the pulmonary arterial smooth muscle cell. The main focus of this review is the cellular and molecular work performed to clarify these intrinsic mechanisms and to determine how they are facilitated and inhibited by the extrinsic influences of other cells. Because the interaction of intrinsic and extrinsic mechanisms is likely to shape expression of HPV in vivo, we relate results obtained in cells to HPV in more intact preparations, such as intact and isolated lungs and isolated pulmonary vessels. Finally, we evaluate evidence regarding the contribution of HPV to the physiological and pathophysiological processes involved in the transition from fetal to neonatal life, pulmonary gas exchange, high-altitude pulmonary edema, and pulmonary hypertension. Although understanding of HPV has advanced significantly, major areas of ignorance and uncertainty await resolution.

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The Effects of Inhaled Nitric Oxide and Its Combination with Intravenous Almitrine on PaO2 During One-Lung Ventilation in Patients Undergoing Thoracoscopic Procedures

Cited by 52 publications

References 18 publications

Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation

Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation

Inhaled NO and almitrine bismesylate in patients with acute respiratory distress syndrome: effect of noradrenalin

Hypoxic Pulmonary Vasoconstriction

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