The role of inhaled nitric oxide beyond ARDS

Khan, Muhammad Faisal; Azfar, Mohammad; Khurshid, Syed Moazzum

doi:10.4103/0972-5229.133931

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Also, it is unclear whether iNO would have a vasodilatory effect on cerebral blood vessels and whether it would be detrimental or neuroprotective in case of ICH. 27,28 The perioperative mortality in HPS patients in the above series was 4.4% which is much lower than reported in the previous studies. 29 Patients with HPS tend to have longer ICU stay, and good intensive care support, monitoring for complications, and successful use of iNO in severe cases are probably the key factors to optimize outcomes in these patients.…”

Section: Casementioning

confidence: 47%

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Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post‐transplant hypoxemia–a single center experience

Raghunathan

Mohan

Dhaliwal

et al. 2020

Pediatric Transplantation

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Data on pediatric patients with HPS undergoing LT are limited. Our aim was to study the spectrum and outcomes of pediatric patients with HPS undergoing LDLT. The role ofiNO for post-LDLT refractory hypoxemia was also assessed. Patients (aged < 18 years) undergoing LT were retrospectively studied. HPS was diagnosed based on European Respiratory Society Taskforce 2004 criteria. HPS was graded based on oxygenation criteria and contrast-enhanced echocardiogram. Postoperative course was studied. Refractory post-operative hypoxemia was treated with iNO by institutionally developed protocol. 23/150 pediatric patients undergoing LDLT had HPS. BA was the most common underlying cause (52.2%). By oxygenation criteria, 6 (26.1%) had VS-HPS. VS-HPS was associated with longer LOS (p = .031) and prolonged oxygen requirement (p = .001) compared with other HPS patients. 4/6 patients with VS-HPS had pO2 < 45 mm Hg. Among these, 2 developed ICH post-operatively and 1 died. 3 developed refractory post-operative hypoxemia, successfully treated with iNO. Mean duration of iNO was 26.3 days. In the group of patients with HPS, the incidence of HAT and portal vein thrombosis was 17.3% and 4.3%, respectively. One year post-LDLT survival of patients with HPS was similar to non-HPS patients (86.9% vs 94.4%; p = .88). We concluded that, pediatric patients with VS-HPS, especially those with pre-operative pO2 < 45 mm Hg, have long and difficult post-LT course. Refractory postoperative hypoxemia can be successfully overcome with strategic use of iNO. Vigilant monitoring and good intensive care support are essential.

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Section: Casementioning

confidence: 47%

“…The complexities of role of polycythemia and anticoagulation in such patients with respect to above thrombotic/hemorrhagic complications require to be looked into further. Also, it is unclear whether iNO would have a vasodilatory effect on cerebral blood vessels and whether it would be detrimental or neuroprotective in case of ICH 27,28 …”

Section: Discussionmentioning

confidence: 99%

Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post‐transplant hypoxemia–a single center experience

Raghunathan

Mohan

Dhaliwal

et al. 2020

Pediatric Transplantation

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“…49,50 Evidence: Case reports and studies suggest pulmonary vasodilators may improve ICP and cerebral oxygenation. [51][52][53][54] Potential complications include hypotension if systemically absorbed, and bleeding because of platelet inhibition. 30 Summary: Limited evidence suggests pulmonary vasodilators are safe and potentially beneficial in sABI and ARDS.…”

Section: Recruitment Maneuvers: Challenge: Recruitment Maneuvers May Open Collapsed Alveoli and Improve Oxygenation But Can Cause Hypotenmentioning

confidence: 99%

Focused Management of Patients With Severe Acute Brain Injury and ARDS

Kim

Wahlster

LaBuzetta

et al. 2022

CHEST

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Considering the COVID-19 pandemic where concomitant occurrence of acute respiratory distress syndrome (ARDS) and severe acute brain injury (sABI) has increasingly co-emerged, we synthesize existing data regarding the simultaneous management of both conditions. Our aim is to provide readers with fundamental principles and concepts for the management of sABI and ARDS, and highlight challenges and conflicts encountered while managing concurrent disease. Up to 40 percent of patients with sABI can develop ARDS. While there are trials and guidelines to support the mainstays of treatment for ARDS and sABI independently, guidance on concomitant management is limited. Treatment strategies aimed at managing severe ARDS may at times conflict with the management of sABI. In this narrative review, we discuss the physiological basis and risks involved during simultaneous management of ARDS and sABI, summarize evidence for treatment decisions, and demonstrate these principles using hypothetical case scenarios. Use of invasive or non-invasive monitoring to assess brain and lung physiology may facilitate goal-directed treatment strategies with the potential to improve outcome. Understanding the pathophysiology and key treatment concepts for co-management of these conditions is critical to optimizing care in this high-acuity patient population.

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Inhaled nitric oxide suppresses neuroinflammation in experimental ischemic stroke

Sienel,

Mamrak,

Biller

et al. 2023

J Neuroinflammation

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Ischemic stroke is a major global health issue and characterized by acute vascular dysfunction and subsequent neuroinflammation. However, the relationship between these processes remains elusive. In the current study, we investigated whether alleviating vascular dysfunction by restoring vascular nitric oxide (NO) reduces post-stroke inflammation. Mice were subjected to experimental stroke and received inhaled NO (iNO; 50 ppm) after reperfusion. iNO normalized vascular cyclic guanosine monophosphate (cGMP) levels, reduced the elevated expression of intercellular adhesion molecule-1 (ICAM-1), and returned leukocyte adhesion to baseline levels. Reduction of vascular pathology significantly reduced the inflammatory cytokines interleukin-1β (Il-1β), interleukin-6 (Il-6), and tumor necrosis factor-α (TNF-α), within the brain parenchyma. These findings suggest that vascular dysfunction is responsible for leukocyte adhesion and that these processes drive parenchymal inflammation. Reversing vascular dysfunction may therefore emerge as a novel approach to diminish neuroinflammation after ischemic stroke and possibly other ischemic disorders.

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The role of inhaled nitric oxide beyond ARDS

Cited by 3 publications

References 14 publications

Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post‐transplant hypoxemia–a single center experience

Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post‐transplant hypoxemia–a single center experience

Focused Management of Patients With Severe Acute Brain Injury and ARDS

Inhaled nitric oxide suppresses neuroinflammation in experimental ischemic stroke

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