Inhaled nitric oxide for high-altitude pulmonary edema
Details
State: Public
Version: Final published version
Serval ID
serval:BIB_C5E7B7A3D75B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Inhaled nitric oxide for high-altitude pulmonary edema
Journal
New England Journal of Medicine
ISSN
0028-4793 (Print)
Publication state
Published
Issued date
03/1996
Volume
334
Number
10
Pages
624-9
Notes
Clinical Trial
Journal Article --- Old month value: Mar 7
Journal Article --- Old month value: Mar 7
Abstract
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.
Keywords
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
Yes
Create date
25/01/2008 14:00
Last modification date
20/08/2019 15:41