Lavoie A, Hall J B, Olson D M, Wylam M E
Department of Medicine and Pediatrics, University of Chicago, Illinois 60637, USA.
Am J Respir Crit Care Med. 1996 Jun;153(6 Pt 1):1985-7. doi: 10.1164/ajrccm.153.6.8665066.
We present the effects of abrupt discontinuation of inhaled nitric oxide (NO) in four patients with severe hypoxemic respiratory failure. These patients ranged from 9 mo to 65 yr of age. In each patient, after the initiation of inhaled NO, a marginal, but immediate, beneficial effect on gas exchange and, when measured, a reduction in pulmonary artery pressures was noted. However, during attempts to discontinue inhaled NO, not only did these patients develop worsening oxygenation and recrudescence of pulmonary hypertension but, unexpectedly, these parameters were worse than the baseline values, leading to life-threatening hemodynamic instability. These effects reversed immediately after reinstitution of inhaled NO. The mechanism of this severe ¿rebound¿ in pulmonary hypertension after abrupt withdrawal of NO is unclear, but its existence emphasizes the need to avoid a substantial risk to these patients. Moreover, we believe that both unintentional and intentional termination of inhaled NO therapy may lead to life-threatening deterioration in gas exchange and circulatory hemodynamics that exceeds the initial therapeutic benefit.
我们介绍了4例严重低氧血症性呼吸衰竭患者突然停用吸入一氧化氮（NO）的影响。这些患者年龄从9个月至65岁不等。在每例患者中，吸入NO开始后，观察到对气体交换有轻微但即刻的有益作用，且肺动脉压（测量时）有所降低。然而，在试图停用吸入NO期间，这些患者不仅出现氧合恶化和肺动脉高压复发，而且出乎意料的是，这些参数比基线值更差，导致危及生命的血流动力学不稳定。重新吸入NO后，这些影响立即逆转。突然停用NO后肺动脉高压出现这种严重“反跳”的机制尚不清楚，但其存在强调了避免给这些患者带来重大风险的必要性。此外，我们认为，无意和有意终止吸入NO治疗都可能导致气体交换和循环血流动力学出现危及生命的恶化，这种恶化超过了最初的治疗益处。
