[Treatment with inhaled nitric oxide in patients with pulmonary embolism]

Pulmonary embolism (PE) is accompanied by mechanical obstruction of pulmonary vascular bed, as well as pulmonary vasoconstriction, resulting as neurohumoral response to acute increase of pressure in pulmonary circulation system. It has been shown that vasospasm is making a significant contribution to pulmonary artery pressure (PAP) increase. Modern treatment of PE is mainly directed at restoring perfusion, while treatment of pulmonary vasoconstriction is overlooked. Nitrogen monoxide (NO) is endothelial mediator that has vasorelaxing and moderate antiplatelet properties that allow correcting the severity of pulmonary vasoconstriction.

To assess efficacy and safety of inhaled NO therapy in complex treatment of PE.

The study involved patients with moderate-low-risk PE (n = 65) who were randomized into two groups: experimental (n = 30, 27 men, 3 women, mean age 53,1 ± 16,8 years) and control group (n = 35, 21 men, 14 women, mean age 56,8 ± 14,1 years old). Patients in experimental group received inhaled NO therapy with standard anticoagulant therapy, while control group received only anticoagulants.

On the 10th day of the study, experimental group showed significantly more pronounced decrease of systolic PAP (sPAP) and right heart sizes compared with control group. There was also statistically significant positive dynamics of vital signs (respiratory rate, heart rate, blood pressure) and dyspnea (mMRC), arterial oxygen partial pressure, nitrosative status (exhaled NO and saliva nitrite), NT-proBNP compared with control group.

Inhaled NO therapy in complex therapy of PE demonstrated safety and efficacy in relation to clinical, functional and laboratory parameters.