Decreased exhaled nitric oxide may be a marker of cardiopulmonary bypass-induced injury

被引:66
作者
Beghetti, M
Silkoff, PE
Caramori, M
Holtby, HM
Slutsky, AS
Adatia, I [1 ]
机构
[1] Hosp Sick Children, Div Cardiol, Toronto, ON M5J 1X8, Canada
[2] Hosp Sick Children, Dept Anesthesia, Toronto, ON M5G 1X8, Canada
[3] Hosp Sick Children, Dept Crit Care Med, Toronto, ON M5G 1X8, Canada
[4] Univ Toronto, Dept Pediat, Toronto, ON, Canada
[5] Univ Toronto, Dept Anesthesia, Toronto, ON, Canada
[6] Univ Toronto, Dept Crit Care Med, Toronto, ON, Canada
[7] Univ Toronto, Div Resp Med, Toronto, ON, Canada
关键词
D O I
10.1016/S0003-4975(98)00447-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Nitric oxide is an endothelium-derived vasodilator. Cardiopulmonary bypass may induce transient pulmonary endothelial dysfunction with decreased nitric oxide release that contributes to postoperative pulmonary hypertension and lung injury. Exhaled nitric oxide levels may reflect, in part, endogenous production from the pulmonary vascular endothelium. Methods. We measured exhaled nitric oxide levels before and 30 minutes after cardiopulmonary bypass in 30 children with acyanotic congenital heart disease and left-to-right intracardiac shunts undergoing repair. Results. Exhaled nitric oxide levels decreased by 27.6% +/- 5.6% from 7 +/- 0.8 to 4.4 +/- 0.5 ppb (p < 0.05) 30 minutes after cardiopulmonary bypass despite a reduction in hemoglobin concentration. Conclusions. The decrease in exhaled nitric oxide levels suggests reduced nitric oxide synthesis as a result of pulmonary vascular endothelial or lung epithelial injury. This may explain the efficacy of inhaled nitric oxide in the treatment of postoperative pulmonary hypertension. Furthermore, strategies aimed at minimizing endothelial dysfunction and augmenting nitric oxide production during cardiopulmonary bypass may decrease the incidence of postoperative pulmonary hypertension. Exhaled nitric oxide levels may be useful to monitor both cardiopulmonary bypass-induced endothelial injury and the effect of strategies aimed at minimizing such injury. (C) 1998 by The Society of Thoracic Surgeons.
引用
收藏
页码:532 / 534
页数:3
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