Pulsed delivery of inhaled nitric oxide to patients with primary pulmonary hypertension - An ambulatory delivery system and initial clinical tests

被引:135
作者
Channick, RN [1 ]
Newhart, JW [1 ]
Johnson, FW [1 ]
Williams, PJ [1 ]
Auger, WR [1 ]
Fedullo, PF [1 ]
Moser, KM [1 ]
机构
[1] UNIV CALIF SAN DIEGO,MED CTR,DEPT RESP CARE,SAN DIEGO,CA 92103
关键词
inhaled nitric oxide; nasal cannulas; outpatient administration; primary pulmonary hypertension; pulsed delivery;
D O I
10.1378/chest.109.6.1545
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Inhaled nitric oxide (NO) has been shown to be a selective pulmonary vasodilator in certain patients with primary pulmonary hypertension (PPH). Objectives: The purpose of this study was to design and test a system for delivery of NO to awaken, ambulatory patients with PPH and to evaluate this system in the home setting. Methods: The ambulatory delivery system consisted of a tank of 80 ppm of NO (balance N-2), a modified gas-pulsing device, and nasal cannulas. The pulsing device was set to deliver NO for 0.1 s at the beginning of each inspiration. Results: Using this system, eight patients with PPH were studied with pulmonary artery catheters in place. Inhalation of NO led to significant reductions in both mean pulmonary arterial pressure (PAPm) (51+/-12 to 43+/-10 mm Hg; p=0.001) and pulmonary vascular resistance (PVR) (790+/-285 to 620+/-208 dyne . s . cm(-5); p=0.01). Three of the eight patients had both greater than 20% and greater than 30% decreases in PAPm and PVR, respectively. No exhaled NO or NO2 was detectable in any of the eight patients. One patient was discharged home from the hospital on a regimen of inhaled NO. At 9 months, no adverse effects were noted and the system was working well. Conclusions: Pulsed delivery of inhaled NO to ambulatory patients with PPH, via nasal prongs, is feasible and, in some patients,leads to significant improvement in pulmonary hypertension. Inhaled 09NO, therefore, may have a role in the long-term treatment of patients with PPH.
引用
收藏
页码:1545 / 1549
页数:5
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