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Clinical Investigations: PULMONARY VASCULATURE |

Effects of Nitric Oxide Inhalation After Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism*

Hideaki Imanaka, MD; Hiroshi Miyano, MD; Muneyuki Takeuchi, MD,; Keiji Kumon, MD,; Motomi Ando, MD
Author and Funding Information

*From the Surgical Intensive Care Unit, National Cardiovascular Center, Osaka, Japan.

Correspondence to: Hideaki Imanaka, MD, Surgical Intensive Care Unit, National Cardiovascular Center, 5–7-1 Fujishiro-dai, Suita, Osaka, Japan 565-8565; e-mail: imanakah@hsp.ncvc.go.jp



Chest. 2000;118(1):39-46. doi:10.1378/chest.118.1.39
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Study objectives: To examine the hypothesis that nitric oxide (NO) inhalation improves hemodynamics and gas exchange in patients with chronic pulmonary thromboembolism after pulmonary thromboendarterectomy.

Design: Prospective crossover clinical study.

Setting: Surgical ICU in a national education and research hospital.

Patients: Seven patients (mean age ± SD, 54 ± 11 years) who underwent elective pulmonary thromboendarterectomy for chronic pulmonary thromboembolism.

Interventions: Patients breathed 20 parts per million of NO gas for 30 min at 12-h intervals until extubation of the trachea.

Measurements and results: Hemodynamics and arterial blood gas levels were analyzed before, during, and after NO inhalation. Waveform of pulmonary artery pressure (PAP) was evaluated using fractional pulse pressure (PPf): (systolic PAP − diastolic PAP)/mean PAP. After surgery, pulmonary vascular resistance decreased, PPf decreased, and cardiac index increased significantly. At the first trial, NO inhalation resulted in a slight improvement in arterial oxygen tension (from 173 ± 33 to 196 ± 44 mm Hg; p < 0.05), while hemodynamics did not change significantly. Twelve hours later, NO inhalation decreased pulmonary vascular resistance index (from 312 ± 98 to 277 ± 93 dyne·s·cm−5/m2; p < 0.01), while the change in oxygenation was not significant.

Conclusions: Immediately after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism, NO inhalation improved oxygenation; at 12 h after surgery, NO inhalation resulted in decreased pulmonary vascular resistance, although both changes were small.

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