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Published on: May 4, 2021
Physiological response following inhaled nitric oxide administration during one-lung ventilation in minimally
Satoshi Kometani1, Shiro Matsuo2, Eri Watanabe2
1Anesthesiology and Intensive Care, Yamato Seiwa Hospital, 9-8-2 Minamirinkan, Yamato, Kanagawa, 242-0006, Japan. kometani@seiwa.or.jp.
Objective:
This study aimed to evaluate the physiological responses following inhaled nitric oxide (iNO) administration in patients with one-lung ventilation (OLV)-related hypoxemia accompanied by pulmonary hypertension in minimally invasive cardiac surgery (MICS).
Methods:
This exploratory prospective cohort study enrolled 63 consecutive patients who underwent MICS. Patients who developed post-cardiopulmonary bypass (CPB) OLV-related hypoxemia with pulmonary hypertension received iNO. The evaluation included changes in PaO2/FiO2 and mean pulmonary artery pressure (mPAP). Additionally, multivariable logistic regression analysis was performed to examine clinical factors associated with iNO initiation.
Results:
Overall, 30 patients (47.6%) received iNO. PaO2/FiO2 significantly increased following iNO administration (70 [61-80] to 85 [72-102], P = 0.011), while mPAP remained unchanged (24 [23-26] to 25 [22-28] mmHg, P = 0.564). Multivariable analysis identified female sex (odds ratio [OR]: 5.00), higher body mass index (OR: 1.36), and prolonged CPB time (OR: 1.03) as associated factors for iNO initiation (area under the curve: 0.822). All patients with a second aortic clamp or pre-CPB hypoxemia met the initiation criteria and received iNO.
Conclusions:
Post-CPB OLV-related hypoxemia accompanied by pulmonary hypertension occurs frequently during MICS. The observed increase in oxygenation following iNO administration suggests its potential utility for respiratory management in MICS, warranting future large-scale, multicenter investigations.
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