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British Journal of Anaesthesia, 1994, Vol. 73, No. 4 499-502
© 1994 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Inhaled nitric oxide in acute respiratory failure in adults

J. D. YOUNG, BM, FRCA, DM, W. J. BRAMPTON, MA, MB, BCHIR, FRCA, J. D. KNIGHTON, MB, BS and S. R. FINFER, MB, BS, MRCP, FRCA

Intensive Care Unit, John Radcliffe Hospital, Headley Way, Oxford 0X3 9DU and Intensive Care Unit, Gloucestershire Royal Hospital Great Western Road, Gloucester GL1 3NN

Correspondence to J.D.Y.

We have assessed the acute effects of inhaled nitric oxide 8, 32 and 128 volumes per million (vpm) on pulmonary haemodynamics and arterial oxygenation in patients with severe acute respiratory failure. Fourteen patients requiring artificial ventilation with mean pulmonary artery pressures greater than 30 mm Hg were given inhaled nitric oxide; haemodynamic values and blood-gas tensions were measured before and after 10 min of inhalation of nitric oxide. Nitric oxide inhaled at 8, 32 and 128 vpm decreased mean pulmonary artery pressure by 1.7 (SD 2.2), 3.2 (2.6) and 3.3 (3.3) mm Hg, pulmonary vascular resistance by 20 (64), 53 (57) and 66 (54) dyn s cm–5 and increased arterial oxygen tension by 2.5 (3.6), 3.0 (5.1) and 2.9 (3.9) kPa, respectively. All changes were significant (P < 0.05 or less) except for changes in pulmonary vascular resistance at 8 vpm. The improvement in arterial oxygenation with 128 vpm was related to pulmonary vascular resistance before commencing nitric oxide. The major beneficial effect of nitric oxide in acute respiratory failure would appear to be improvement in oxygenation rather than reduction in pulmonary artery pressure. The degree of improvement in arterial oxygenation with nitric oxide was related directly to pulmonary vascular resistance before treatment.

Present address: Nuffield Department of Anaesthetics, Radcliffe Infirmary, Woodstock Road, Oxford 0X2 6HE

Present address: Cheltenham General Hospital, Sandlord Road, Cheltenham GL53 7AN

Present address: Department of Anaesthetics, Southampton General Hospital, Tremona Road, Southampton SO9 4XY

Present address: Intensive Therapy Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia


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