Abstract
Objectives
Inhalation of nitric oxide (NO) selectively dilates pulmonary vessels in well-ventilated regions. Prostaglandin F2α (PGF2α) is a vasoconstrictor and is reported to enhance hypoxic pulmonary vasoconstriction. The objective of this study was to examine whether the combination of intravenous PGF2α and inhaled NO in ARDS lungs has a beneficial effect on oxygenation.
Design
We investigated the effect of intravenous PGF2α infusion (0.05–10.0 μg/kg per min) with and without NO inhalation (60 ppm) on the hemodynamics and gas exchange in an ovine ARDS model, examining the pulmonary artery pressure versure the flow plot by varying cardiac output.
Measurements and results
After lung lavage, NO inhalation reduced the mean pulmonary arterial pressure (MPAP) by decreasing the zero-flow pressure intercept from 10.6±3.8 (mean±SD) to 8.5±3.8 mmHg (p<0.05) with no significant change in slope. NO inhalation improved PaO2 from 56±12 to 84±38 mmHg (p<0.005) and reduced pulmonary shunt from 65±5 to 53±8% (\(\dot Qs/\dot Qt\)) (p<0.001). The dose-dependent effects of PGF2α infusion were: (1) increased MPAP attributed to an increased slope in pulmonary artery pressure-flow plot; (2) decreased cardiac index; (3) decreased\(\dot Qs/\dot Qt\) with unchanged PaO2. The dose-dependent decrease in\(\dot Qs/\dot Qt\) after PGF2α infusion was attributed to the decreased cardiac output.
Conclusions
It is suggested that inhalation of NO reduced the critical vascular pressure near alveoli without affecting upstream vessels, while infused PGF2α constricted the larger upstream pulmonary artery vessels without appreciably affecting the critical pressure. Inhalation of NO into well-ventilated lung areas shifted perfusion to well-oxygenated areas, and there was no supplemental shift in blood flow by adding an infusion of PGF2α.
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This study was supported by USPHS grant HL 42391 to W.M.Z. and a Kitasato Research Foundation grant to H.K.
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Kobayashi, H., Tanaka, N., Winkler, M. et al. Combined effects of NO inhalation and intravenous PGF2α on pulmonary circulation and gas exchange in an ovine ARDS model. Intensive Care Med 22, 656–663 (1996). https://doi.org/10.1007/BF01709742
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DOI: https://doi.org/10.1007/BF01709742