Rebound Pulmonary Hypertension After Nitric Oxide Withdrawal

Lee, Hyun Woo; Lee, Jae Woong; Hyun, Sung Yeol; Park, Chul Hyun; Park, Kook Yang; Lee, Gyung Chun

Abstract

BACKGROUND: Inhaled nitric oxide therapy causes selective pulmonary vasodilation in congenital heart diseases with pulmonary hypertension. However discontinuation of inhaled nitric oxide therapy may be complicated by abrupt life-threatening rebound pulmonary hypertension(RPH) The purpose of this study was to prevent by comparing group I(without RPH n=13) and group II(with RPH n=6) to determine the risk factors involved inthe development of the RPH. MATERIAL AND METHOD: Between Januarty 6, 1998 and April 14, 1999. we studied 19 consecutive children who were treated with inhaled nitric oxide for clinically significant pulmonary hypertension after an open heart surgery for congenital heart disease. the ratio of males and females was 12:7 ranging in age from 10 days to 6040 days(16 years) To identify the effects of nitric oxide between two groups we measured heart rate mean and systolic pulmonary arterial pressure mean and systolic systemic arterial pressure central venous pressure pH paO2/FiO2 and O2 saturation before and after the initiation and just before the withdrawal of the inhaled nitric oxide. RESULT: In 6 of 19 patients(32%) withdrawal of inhaled nitric oxide caused RPH. In the two groups inhaled nitrix oxide decreased in pulmonary arterial pressure(PAP) without decreasing the systemic arterial pressure(SAP) and increased PaO2/FiO2 Compared with patients who had no RPH(group I) patients who had RPH(group II) were older in age (1204+/-1688 versus 546+/-1654 days p<0.05) received less nitric oxide therapy(34+/-18 versus 67+/-46 hours p<0.05) has shorter weaning process(5+/-3 versus 15-13 hours p<0.05) and received lowerconcentration of initial nitric oxide supply(11+/-8 versus 17+/-8 ppm p>0.05) and lower concentration just before the withdrawal nitric oxide(4.2+/-2.6 versus 5.6+/-2.6 ppm, p>0.05)
CONCLUSION
We speculate that older age shorter of nitric oxide therapy shorter weaning process are the risk factors of RPH.