Abstract:
:The aim of this prospective study was to determine factors influencing effects of inhaled nitric oxide (NO) on the pulmonary circulation and on gas exchange in critically ill patients with acute lung injury. Twenty-one hypoxemic patients with acute respiratory failure (PaO2 = 127 +/- 69 mm Hg during intermittent positive pressure ventilation, FiO2 = 1), were mechanically ventilated with 2 ppm NO and pure oxygen. The effect of positive end-expiratory pressure (PEEP) on alveolar recruitment was assessed on an anatomic basis using a high-resolution and spiral thoracic computed tomographic (CT) scan. Four conditions were studied in random order: zero end-expiratory pressure (ZEEP), ZEEP + 2 ppm NO, 10 cm H2O PEEP, 10 cm H2O PEEP + 2 ppm NO. During ZEEP and PEEP, NO significantly decreased pulmonary vascular resistance index (PVRI), mean pulmonary arterial pressure (MPAP), true pulmonary shunt (Qs/QT), and alveolar dead space (VDA/VT) and significantly increased PaO2 (p < 0.01). During ZEEP, NO-induced decreases in PVRI (delta PVRI) and MPAP (delta MPAP) were significantly correlated to baseline PVRI and MPAP (delta PVRI = -0.5 PVRI + 125, r = 0.97, p < 0.01 and delta MPAP = -0.28 MPAP + 4.8, r = 0.69, p < 0.05). These changes were not potentiated by PEEP-induced alveolar recruitment. The NO-induced increase in PaO2 (delta PaO2) was not significantly correlated with baseline PaO2 but was correlated with baseline PVRI (delta PaO2 = 0.11 PVRI + 30, r = 0.67, p < 0.05). In patients in whom PEEP was associated with alveolar recruitment, NO increased PaO2 by 66 +/- 24 mm Hg during ZEEP and by 104 +/- 26 mm Hg during PEEP (p < 0.01). In patients in whom PEEP did not induce alveolar recruitment, the NO-induced increase in PaO2 was similar during ZEEP and PEEP conditions (+70 +/- 15 mm Hg versus +76 +/- 12 mm Hg, NS). In patients with adult respiratory distress syndrome, factors determining NO-induced improvement in arterial oxygenation and pulmonary vascular effects are PEEP-induced alveolar recruitment and the baseline level of pulmonary vascular resistance.
journal_name
Am J Respir Crit Care Medauthors
Puybasset L,Rouby JJ,Mourgeon E,Cluzel P,Souhil Z,Law-Koune JD,Stewart T,Devilliers C,Lu Q,Roche Sdoi
10.1164/ajrccm.152.1.7599840subject
Has Abstract,Author List Incompletepub_date
1995-07-01 00:00:00pages
318-28issue
1eissn
1073-449Xissn
1535-4970journal_volume
152pub_type
临床试验,杂志文章,随机对照试验abstract::Diseases of the respiratory tract are among the leading causes of death in the world population. Increasing evidence points to a key role of the innate immune system with its pattern recognition receptors (PRRs) in both infectious and noninfectious lung diseases, which include pneumonia, chronic obstructive pulmonary ...
journal_title:American journal of respiratory and critical care medicine
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abstract:RATIONALE:An asthma predisposition locus on chromosome 17q12-q21 has recently been replicated in different ethnic groups. OBJECTIVES:To characterize the asthma and atopy phenotypes in early childhood that associate with the 17q12-21 locus. METHODS:The single nucleotide polymorphism (SNP), rs7216389, was genotyped in ...
journal_title:American journal of respiratory and critical care medicine
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journal_title:American journal of respiratory and critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 临床试验,杂志文章
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更新日期:2000-10-01 00:00:00
abstract::The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year ol...
journal_title:American journal of respiratory and critical care medicine
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