TY - JOUR
T1 - Life-threatening effects of discontinuing inhaled nitric oxide in severe respiratory failure
AU - Lavoie, Annick
AU - Hall, Jesse B.
AU - Olson, David M.
AU - Wylam, Mark E.
PY - 1996
Y1 - 1996
N2 - 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.
AB - 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.
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U2 - 10.1164/ajrccm.153.6.8665066
DO - 10.1164/ajrccm.153.6.8665066
M3 - Article
C2 - 8665066
AN - SCOPUS:0029951898
SN - 1073-449X
VL - 153
SP - 1985
EP - 1987
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 6 I
ER -