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Nitric oxide is superior to prostacyclin for pulmonary hypertension after cardiac operations

A P Goldman1, R E Delius, J E Deanfield

  • 1Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.

The Annals of Thoracic Surgery
|August 1, 1995
PubMed

Insights

Inhaled nitric oxide significantly reduced pulmonary arterial pressure more effectively than intravenous prostacyclin in children with severe postoperative pulmonary hypertension. Nitric oxide is a preferred treatment for this condition.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Pharmacology
  • Critical Care Medicine

Background:

  • Severe pulmonary hypertension is a significant complication in children following cardiac surgery.
  • This condition contributes to increased morbidity and mortality rates.
  • Effective management of postoperative pulmonary hypertension is crucial.

Purpose of the Study:

  • To compare the efficacy of inhaled nitric oxide versus intravenous prostacyclin.
  • To evaluate their vasodilator properties in treating severe postoperative pulmonary hypertension.
  • To determine the preferred treatment option for this critical condition.

Main Methods:

  • A prospective, randomized cross-over study was conducted.
  • Thirteen pediatric patients (3 days to 12 months) with severe pulmonary hypertension were enrolled.
  • Patients received inhaled nitric oxide (20 ppm x 10 min) and intravenous prostacyclin (20 ng.kg-1.min-1 x 10 min).

Main Results:

  • Both treatments reduced pulmonary arterial pressure.
  • Inhaled nitric oxide therapy resulted in a significantly lower mean pulmonary arterial pressure (28.5 +/- 2.9 mm Hg) compared to prostacyclin (35.4 +/- 2.1 mm Hg).
  • The pulmonary to systemic arterial pressure ratio was significantly lower with nitric oxide (0.46 +/- 0.04) versus prostacyclin (0.68 +/- 0.05), as prostacyclin also lowered systemic blood pressure.

Conclusions:

  • Inhaled nitric oxide demonstrated superior effectiveness and selectivity as a pulmonary vasodilator.
  • It proved more advantageous than intravenous prostacyclin in this pediatric population.
  • Inhaled nitric oxide should be considered the preferred treatment for severe postoperative pulmonary hypertension.
Abstract

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