Skip to main content
SpringerLink
Log in

Inhaled Nitric Oxide Therapy in Adult Cardiac Surgery

  • Conference paper
Intensive Care Medicine

  • 1345 Accesses

Abstract

Nitric oxide (NO) is a naturally-occurring free radical that exists as a colorless and odorless gas. In biological solutions, NO is highly diffusible both in water and through biological membranes, with a half-life measured in seconds. Prior to the recognition that NO was the same molecule as an endothelium-derived relaxing factor some 20 years ago [1] it was considered to be mainly an environmental pollutant. However, NO is now recognized as an endogenously produced vasodilator that modulates vascular tone and, thereby, regulates systemic and pulmonary blood flow. It has also been found to have diverse roles throughout mammalian physiology, including neurotransmission and host defense.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Palmer RM, Ferrige AG, Moncada S (1987) Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 327: 524–526

    Article  CAS  PubMed  Google Scholar 

  2. McCarthy HO, Coulter JA, Robson T, Hirst DG (2008) Gene therapy via inducible nitric oxide synthase: a tool for the treatment of a diverse range of pathological conditions. J Pharm Pharmacol 60: 999–1017

    Article  CAS  PubMed  Google Scholar 

  3. Davidson SM, Duchen MR (2006) Effects of NO on mitochondrial function in cardiomyocytes: Pathophysiological relevance. Cardiovasc Res 71: 10–21

    Article  CAS  PubMed  Google Scholar 

  4. Lundberg JO, Weitzberg E, Gladwin MT (2008) The nitrate-nitrite-nitric oxide pathway in physiology and therapeutics. Nat Rev Drug Discov 7: 156–167

    Article  CAS  PubMed  Google Scholar 

  5. McMahon TJ, Doctor A (2006) Extrapulmonary effects of inhaled nitric oxide: role of reversible S-nitrosylation of erythrocytic hemoglobin. Proc Am Thorac Soc 3: 153–160

    Article  PubMed  Google Scholar 

  6. Cokic VP, Schechter AN (2008) Effects of nitric oxide on red blood cell development and phenotype. Curr Top Dev Biol 82 169–215

    Article  CAS  PubMed  Google Scholar 

  7. Young JD, Sear JW, Valvini EM (1996) Kinetics of methaemoglobin and serum nitrogen oxide production during inhalation of nitric oxide in volunteers. Br J Anaesth 76: 652–656

    CAS  PubMed  Google Scholar 

  8. Griffiths MJ, Evans TW (2005) Inhaled nitric oxide therapy in adults. N Engl J Med 353: 2683–2695

    Article  CAS  PubMed  Google Scholar 

  9. Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328: 399–405

    Article  CAS  PubMed  Google Scholar 

  10. Mannick JB (2006) Immunoregulatory and antimicrobial effects of nitrogen oxides. Proc Am Thorac Soc 3: 161–165

    Article  CAS  PubMed  Google Scholar 

  11. Morita K, Ihnken K, Buckberg GD, Sherman MP, Ignarro LJ (1996) Pulmonary vasoconstriction due to impaired nitric oxide production after cardiopulmonary bypass. Ann Thorac Surg 61: 1775–1780

    Article  CAS  PubMed  Google Scholar 

  12. Wessel DL, Adatia I, Giglia TM, Thompson JE, Kulik TJ (1993) Use of inhaled nitric oxide and acetylcholine in the evaluation of pulmonary hypertension and endothelial function after cardiopulmonary bypass. Circulation 88: 2128–2138

    CAS  PubMed  Google Scholar 

  13. Gianetti J, Del Sarto P, Bevilacqua S, et al (2004) Supplemental nitric oxide and its effect on myocardial injury and function in patients undergoing cardiac surgery with extracorporeal circulation. J Thorac Cardiovasc Surg 127: 44–50

    Article  CAS  PubMed  Google Scholar 

  14. Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME (2002) Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesth Analg 95: 1507–1518

    Article  PubMed  Google Scholar 

  15. Vlahakes GJ (2005) Right ventricular failure following cardiac surgery. Coron Artery Dis 16: 27–30

    Article  PubMed  Google Scholar 

  16. Klima U, Guerrero JL, Vlahakes GJ (1998) Contribution of the interventricular septum to maximal right ventricular function. Eur J Cardiothorac Surg 14: 250–255

    Article  CAS  PubMed  Google Scholar 

  17. De Simone R, Wolf I, Mottl-Link S, et al (2005) Intraoperative assessment of right ventricular volume and function. Eur J Cardiothorac Surg 27: 988–993

    Article  PubMed  Google Scholar 

  18. Germann P, Braschi A, Della Rocca G, et al (2005) Inhaled nitric oxide therapy in adults: European expert recommendations. Intensive Care Med 31: 1029–1041

    Article  PubMed  Google Scholar 

  19. Gerlach H, Keh D, Semmerow A, et al (2003) Dose-response characteristics during long-term inhalation of nitric oxide in patients with severe acute respiratory distress syndrome: a prospective, randomized, controlled study. Am J Respir Crit Care Med 167: 1008–1015

    Article  PubMed  Google Scholar 

  20. George I, Xydas S, Topkara VK, et al (2006) Clinical indication for use and outcomes after inhaled nitric oxide therapy. Ann Thorac Surg 82: 2161–2169

    Article  PubMed  Google Scholar 

  21. Rich GF, Murphy GD Jr, Roos CM, Johns RA (1993) Inhaled nitric oxide. Selective pulmonary vasodilation in cardiac surgical patients. Anesthesiology 78: 1028–1035

    Article  CAS  PubMed  Google Scholar 

  22. Snow DJ, Gray SJ, Ghosh S, et al (1994) Inhaled nitric oxide in patients with normal and increased pulmonary vascular resistance after cardiac surgery. Br J Anaesth 72: 185–189

    Article  CAS  PubMed  Google Scholar 

  23. Hare JM, Shernan SK, Body SC, Graydon E, Colucci WS, Couper GS (1997) Influence of inhaled nitric oxide on systemic flow and ventricular filling pressure in patients receiving mechanical circulatory assistance. Circulation 95: 2250–2253

    CAS  PubMed  Google Scholar 

  24. Della Rocca G, Pugliese F, Antonini M, et al (1997) Hemodynamics during inhaled nitric oxide in lung transplant candidates. Transplant Proc 29: 3367–3370

    Article  PubMed  Google Scholar 

  25. Solina AR, Ginsberg SH, Papp D, et al (2002) Response to nitric oxide during adult cardiac surgery. J Invest Surg 15: 5–14

    Article  PubMed  Google Scholar 

  26. Solina A, Papp D, Ginsberg S, et al (2000) A comparison of inhaled nitric oxide and milrinone for the treatment of pulmonary hypertension in adult cardiac surgery patients. J Cardiothorac Vasc Anesth 14: 12–17

    Article  CAS  PubMed  Google Scholar 

  27. Fattouch K, Sbraga F, Sampognaro R, et al (2006) Treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized, prospective, double-blind study. J Cardiovasc Med 7: 119–123

    Google Scholar 

  28. Anderson CA, Filsoufi F, Aklog L, Farivar RS, Byrne JG, Adams DH (2002) Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability. Ann Thorac Surg 73: 1484–1488

    Article  PubMed  Google Scholar 

  29. Christenson JT, Maurice J, Simonet F, Velebit V, Schmuziger M (1996) Open chest and delayed sternal closure after cardiac surgery. Eur J Cardiothorac Surg 10: 305–311

    Article  CAS  PubMed  Google Scholar 

  30. Haddad F, Denault AY, Couture P, et al (2007) Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. J Am Soc Echocardiogr 20: 1065–1072.

    Article  PubMed  Google Scholar 

  31. Healy DG, Veerasingam D, McHale J, Luke D (2006) Successful perioperative utilisation of inhaled nitric oxide in mitral valve surgery. J Cardiovasc Surg (Torino) 47: 217–220

    CAS  Google Scholar 

  32. Girard C, Lehot JJ, Pannetier JC, Filley S, Ffrench P, Estanove S (1992) Inhaled nitric oxide after mitral valve replacement in patients with chronic pulmonary artery hypertension. Anesthesiology 77: 880–883

    Article  CAS  PubMed  Google Scholar 

  33. Santini F, Casali G, Franchi G, et al (2005) Hemodynamic effects of inhaled nitric oxide and phosphodiesterase inhibitor (dipyridamole) on secondary pulmonary hypertension following heart valve surgery in adults. Int J Cardiol 103: 156–163

    Article  PubMed  Google Scholar 

  34. Beck JR, Mongero LB, Kroslowitz RM, et al (1999) Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery. Perfusion 14: 37–42

    CAS  PubMed  Google Scholar 

  35. Price S, Jaggar SI, Jordan S, et al (2007) Adult congenital heart disease: intensive care management and outcome prediction. Intensive Care Med 33: 652–659

    Article  PubMed  Google Scholar 

  36. Ochiai Y, McCarthy PM, Smedira NG, et al (2002) Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation 106 (Suppl 1):I198–202

    PubMed  Google Scholar 

  37. Wagner F, Dandel M, Gunther G, et al (1997) Nitric oxide inhalation in the treatment of right ventricular dysfunction following left ventricular assist device implantation. Circulation 96 (Suppl 9): II-291–II-296

    Google Scholar 

  38. Kaul TK, Fields BL (2000) Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis. Cardiovasc Surg 8: 1–9

    Article  CAS  PubMed  Google Scholar 

  39. Mosquera I, Crespo-Leiro MG, Tabuyo T, et al (2002) Pulmonary hypertension and right ventricular failure after heart transplantation: usefulness of nitric oxide. Transplant Proc 34: 166–167

    Article  CAS  PubMed  Google Scholar 

  40. Stobierska-Dzierzek B, Awad H, Michler RE (2001) The evolving management of acute rightsided heart failure in cardiac transplant recipients. J Am Coll Cardiol 38: 923–931

    Article  CAS  PubMed  Google Scholar 

  41. King RC, Binns OA, Rodriguez F, et al (2000) Reperfusion injury significantly impacts clinical outcome after pulmonary transplantation. Ann Thorac Surg 69: 1681–1685

    Article  CAS  PubMed  Google Scholar 

  42. de Perrot M, Liu M, Waddell TK, Keshavjee S (2003) Ischemia-reperfusion-induced lung injury. Am J Respir Crit Care Med 167: 490–511

    Article  PubMed  Google Scholar 

  43. Kemming GI (1998) Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation. Munich Lung Transplant Group. Intensive Care Med 24: 1173–1180

    Article  CAS  PubMed  Google Scholar 

  44. Miller OI, Tang SF, Keech A, Pigott NB, Beller E, Celermajer DS (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: a randomised double-blind study. Lancet 356: 1464–1469

    Article  CAS  PubMed  Google Scholar 

  45. Dickstein ML (2005) Con: inhaled prostaglandin as a pulmonary vasodilator instead of nitric oxide. J Cardiothorac Vasc Anesth 19: 403–405

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    B. C. Creagh-Brown & T. W. Evans

Authors
  1. B. C. Creagh-Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. W. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Universitée libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Creagh-Brown, B.C., Evans, T.W. (2009). Inhaled Nitric Oxide Therapy in Adult Cardiac Surgery. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_48

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92278-2_48

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92277-5

  • Online ISBN: 978-0-387-92278-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation