Inhaled nitric oxide for high-altitude pulmonary edema

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Etat: Serval
Version: Final published version
ID Serval
serval:BIB_C5E7B7A3D75B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Inhaled nitric oxide for high-altitude pulmonary edema
Périodique
New England Journal of Medicine
Auteur(s)
Scherrer  U., Vollenweider  L., Delabays  A., Savcic  M., Eichenberger  U., Kleger  G. R., Fikrle  A., Ballmer  P. E., Nicod  P., Bartsch  P.
ISSN
0028-4793 (Print)
Statut éditorial
Publié
Date de publication
03/1996
Volume
334
Numéro
10
Pages
624-9
Notes
Clinical Trial
Journal Article --- Old month value: Mar 7
Résumé
BACKGROUND. Pulmonary hypertension is a hallmark of high-altitude pulmonary edema and may contribute to its pathogenesis. When administered by inhalation, nitric oxide, an endothelium-derived relaxing factor, attenuates the pulmonary vasoconstriction produced by short-term hypoxia. METHODS. We studied the effects of inhaled nitric oxide on pulmonary-artery pressure and arterial oxygenation in 18 mountaineers prone to high-altitude pulmonary edema and 18 mountaineers resistant to this condition in a high altitude laboratory (altitude, 4559 m). We also obtained lung-perfusion scans before and during nitric oxide inhalation to gain further insight into the mechanism of action of nitric oxide. RESULTS. In the high-altitude laboratory, subjects prone to high-altitude pulmonary edema had more pronounced pulmonary hypertension and hypoxemia than subjects resistant to high-altitude pulmonary edema. Arterial oxygen saturation was inversely related to the severity of pulmonary hypertension (r=-0.50, P=0.002). In subjects prone to high-altitude pulmonary edema, the inhalation of nitric oxide (40 ppm for 15 minutes) produced a decrease in mean (+/-SD) systolic pulmonary-artery pressure that was three times larger than the decrease in subjects resistant to such edema (25.9+/-8.9 vs. 8.7+/-4.8 mm Hg, P<0.001). Inhaled nitric oxide improved arterial oxygenation in the 10 subjects who had radiographic evidence of pulmonary edema (arterial oxygen saturation increased from 67+/-10 to 73+/-12 percent, P=0.047), whereas it worsened oxygenation in subjects resistant to high-altitude pulmonary edema. The nitric oxide-induced improvement in arterial oxygenation in subjects with high-altitude pulmonary edema was accompanied by a shift in blood flow in the lung away from edematous segments and toward nonedematous segments. CONCLUSIONS. The inhalation of nitric oxide improves arterial oxygenation in high-altitude pulmonary edema, and this beneficial effect may be related to its favorable action on the distribution of blood flow in the lungs. A defect in nitric nitric oxide synthesis may contribute to high-altitude pulmonary edema.
Mots-clé
Administration, Inhalation Adult Altitude Sickness/complications Carbon Dioxide/analysis Echocardiography, Doppler Female Humans Hypertension, Pulmonary/complications/drug therapy/ultrasonography Lung/blood supply/radiography/radionuclide imaging Male Middle Aged Nitric Oxide/*therapeutic use Oxygen/blood Pulmonary Edema/*drug therapy/etiology/physiopathology
Pubmed
Web of science
Open Access
Oui
Création de la notice
25/01/2008 15:00
Dernière modification de la notice
09/05/2019 1:01
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