ISSN:
1432-1238
Keywords:
Inhaled nitric oxide
;
Almitrine bismesylate
;
Adult respiratory distress syndrome
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange. Design Prospective self-controlled study. Setting 3 medico-surgical intensive care units. Patients 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88±30mmHg, venous admixture: 47±7%) and elevated mean pulmonary artery pressure (MPAP: 30±5mmHg) due to adult respiratory distress syndrome (ARDS). Interventions 5 conditions were studied: 1) baseline, 2) 5 to 10ppm of NO during 30min, 3) discontinuation of NO during 30min, 4) ALM infusion (0.5mg/kg) during 30min, 5) ALM infusion (0.5mg/kg) during 30min in combination with 5 to 10ppm of NO. Measurement and results The PaO2/FIO2 ratio rose from 88±30 to 98±37mmHg (NS) with NO alone, and from 92±25 to 130±56mmHg (p〈0.01) with NO+ALM (p〈0.05 vs NO alone). Seven patients were considered as “NO-responders” (rise in PaO2/FIO2 ratio of 10mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87±30 to 128±39mmHg (p〈0.05) with NO alone, and from 93±20 to 169±51mmHg (p〈0.01) with NO+ALM (p〈0.05 versus NO alone). MPAP decreased from 30±5 to 26±5mmHg (p〈0.01) with NO alone, increased slightly from 28±5 to 31±5mmHg (NS) with ALM alone and decreased to 27±5mmHg (p〈0.05) with NO+ALM. Conclusions NO+ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01708960
