Chest
Clinical Investigations: Nitric OxidePulsed Delivery of Inhaled Nitric Oxide to Patients With Primary Pulmonary Hypertension: An Ambulatory Delivery System and Initial Clinical Tests
Section snippets
MATERIALS AND METHODS
This study was approved by the Institutional Human Subjects Committee. Informed consent was obtained from the patients.
Delivery and Monitoring
The delivery device functioned without problems. NO was delivered with each breath. Neither NO nor NO2 was detected in the expired gas or ambient air.
The ambulatory patient had no difficulty with the portable system and was able to ambulate in the halls, eat, and bathe. This patient was discharged home from the hospital with an ambulatory system. Large, stationary tanks and small, portable tanks of NO were used to provide continuous NO inhalation.
Hemodynamic and Gas Exchange Results
Hemodynamic data at baseline and 15 min into NO
DISCUSSION
In this study, we have reported details of an NO delivery system that is practical for ambulatory patients. We have demonstrated the reliability of this system in the clinical setting. Finally, we have demonstrated safety and feasibility of the system in eight patients with PPH and, in three patients, we have demonstrated marked reduction in PAPm and PVR with very short NO pulses. One patient was discharged home from the hospital on a regimen of inhaled NO delivered via this system and is
ACKNOWLEDGMENTS
The authors thank Diane McIntyre and Katie Kinninger for their technical assistance in this study.
REFERENCES (16)
- et al.
Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension
Lancet
(1991) - et al.
Inhaled nitric oxide reverses hypoxic pulmonary vasoconstriction in dogs: a practical nitric oxide delivery and monitoring system
Chest
(1994) - et al.
Vascular endothelial cells synthesize nitric oxide from L-arginine
Nature
(1988) Biological actions and properties of endothelium-derived nitric oxide formed and released from artery and vein
Circ Res
(1989)- et al.
Inhaled nitric oxide in congenital heart disease
Circulation
(1993) - et al.
Responses to infusion of acetylcholine and inhalation of nitric oxide in patients with chronic obstructive lung disease and pulmonary hypertension
Am Rev Respir Dis
(1992) - et al.
Improvement in hypoxemia and pulmonary hypertension following nitric oxide inhalation in a patient with end-stage pulmonary fibrosis
Am J Respir Crit Care Med
(1994) - et al.
Primary pulmonary hypertension: a national prospective study
Ann Intern Med
(1987)
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2018, JACC: Basic to Translational ScienceCitation Excerpt :Combining our current data with previous findings, we speculate that chronic VNS induces general suppression of inflammatory responses, improves PA cell proliferation/apoptosis imbalance, and attenuates pulmonary vascular remodeling. It is well known that VNS releases acetylcholine and induces local NO production in heart and systemic arteries (28,36) and that the increase in NO lowers PVR in PAH (37). However, acute VNS did not change eNOS and phosphorylated eNOS protein levels or pulmonary vascular characteristics (Figure 9).
This study was supported, in part, by Nellcor Puritan Bennett Corporation, Pleasanton, Calif, and Apria Healthcare.
revision accepted November 3.