Tremblay Jan-Alexis, Couture Étienne J, Albert Martin, Beaubien-Souligny William, Elmi-Sarabi Mahsa, Lamarche Yoan, Denault André Y
Department of Medicine, Division of Critical Care, Université de Montréal, Montreal, QC, Canada.
Department of Medicine, Division of Critical Care, Université de Montréal, Montreal, QC, Canada; Department of Medicine and Critical Care, Sacré-Coeur Hospital and Montreal Heart Institute, Montreal, QC, Canada.
J Cardiothorac Vasc Anesth. 2019 Mar;33(3):642-647. doi: 10.1053/j.jvca.2018.08.004. Epub 2018 Aug 8.
The authors aimed to assess the hemodynamic effects and demonstrate the feasibility of inhaled nitric oxide (iNO) in hemodynamically unstable patients with acute right ventricular (RV) dysfunction and to explore the safety profile of this approach.
Retrospective cohort study.
Intensive care unit (ICU) of 2 tertiary care centers between January 2013 and 2017.
All patients with RV dysfunction in whom iNO was initiated without invasive mechanical ventilation.
Noninvasive administration of iNO.
Eighteen patients received the intervention during the study period; 8 of these patients had a pulmonary artery catheter and 2 had a pulse contour analysis device. Median (interquartile range) iNO concentration was 20 (20-20) ppm, and therapy duration was 24 (12-46) hours. Most patients received iNO through nasal prongs (66.7%) or a high-flow nasal cannula (27.8%). Within 1 hour, iNO reduced pulmonary vascular resistance from 219.1 to 165.4 dyn•s/cm (n = 7; p < 0.001), mean pulmonary artery pressure from 28.4 to 25.3 mmHg (n = 8; p = 0.01), and central venous pressure from 17.5 to 13.1 mmHg (n = 16; p = 0.001). Indexed cardiac output increased from 2.0 to 2.6 L/min/m (n = 9; p = 0.004). ICU mortality was 27.78%, and median ICU length of stay was 7 (5-9) days. Two significant bleeding episodes requiring intervention and 1 acute kidney injury occurred during iNO therapy. No headache was reported.
Noninvasively administered iNO was associated with favorable hemodynamic effects in ICU patients with acute RV dysfunction. These results suggest the safety and feasibility of this therapy for which further prospective study is warranted.
作者旨在评估吸入一氧化氮（iNO）对血流动力学不稳定的急性右心室（RV）功能障碍患者的血流动力学影响，并证明其可行性，同时探讨该方法的安全性。
回顾性队列研究。
2013年1月至2017年期间，2家三级医疗中心的重症监护病房（ICU）。
所有在未进行有创机械通气的情况下开始使用iNO的RV功能障碍患者。
iNO的无创给药。
18例患者在研究期间接受了干预；其中8例患者有肺动脉导管，2例患者有脉搏轮廓分析装置。iNO浓度的中位数（四分位间距）为20（20 - 20）ppm，治疗持续时间为24（12 - 46）小时。大多数患者通过鼻导管（66.7%）或高流量鼻导管（27.8%）接受iNO治疗。在1小时内，iNO使肺血管阻力从219.1降至165.4 dyn•s/cm（n = 7；p < 0.001），平均肺动脉压从28.4降至25.3 mmHg（n = 8；p = 0.01），中心静脉压从17.5降至13.1 mmHg（n = 16；p = 0.001）。心指数从2.0升至2.6 L/min/m（n = 9；p = 0.004）。ICU死亡率为27.78%，ICU住院时间中位数为7（5 - 9）天。在iNO治疗期间发生了2次需要干预的严重出血事件和1例急性肾损伤。未报告头痛情况。
无创给予iNO对ICU中急性RV功能障碍患者具有良好的血流动力学影响。这些结果表明该治疗方法的安全性和可行性，值得进一步进行前瞻性研究。
