Inhaled nitric oxide increases endothelin-1 levels: a potential cause of rebound pulmonary hypertension

Critical Care Medicine
Jeffrey M PearlJodie Y Duffy

Abstract

Inhaled nitric oxide (iNO) is front-line therapy for pulmonary hypertension after repair of congenital heart disease. However, little clinical data exists regarding the effects of iNO on regulators of pulmonary vascular resistance. An imbalance between primary vasodilators, such as NO, and vasoconstrictors, such as endothelin-1 (ET-1), has been implicated in rebound pulmonary hypertension upon iNO withdrawal. The objective of this study was to determine whether iNO therapy alters plasma ET-1 levels. This is a prospective study involving pediatric and adult patients at risk for pulmonary hypertension. Pediatric patients were in the cardiac intensive care unit and adult patients were in a tertiary-care hospital. Group 1 included children with congenital heart disease requiring iNO for treatment of pulmonary hypertension after cardiopulmonary bypass (n = 15), group 2 was adults receiving iNO (n = 10), and group 3 included children at risk for pulmonary hypertension after bypass that did not require iNO (n = 8). Dosages of iNO were 2-60 ppm. The duration of therapy ranged from 23 to 188 hrs in group 1 and 29 to 108 hrs in group 2. Arterial blood was obtained for the measurement of ET-1 levels before and during iNO therapy and 24 hr...Continue Reading

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