Why the study?
Does combined inhaled nitric oxide and inhaled iloprost improve hypoxaemia in a patient with acute pulmonary hypertension after pulmonary thrombo-endarterectomy?
Does combined inhaled nitric oxide and inhaled iloprost improve hypoxaemia in a patient with acute pulmonary hypertension after pulmonary thrombo-endarterectomy?
Combined inhaled nitric oxide and inhaled iloprost may be a reasonable rescue therapy for acute postoperative pulmonary hypertension when single vasodilator therapy fails.
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May support combined inhaled vasodilators as rescue for refractory postoperative pulmonary hypertension; hypothesis-generating single case leaves efficacy unproven.
Acute pulmonary hypertension with life-threatening right heart failure may complicate the postoperative course following cardiothoracic surgery. Both inhaled nitric oxide and inhaled iloprost, a stable analogue of prostacyclin, have been used frequently for this purpose in acute pulmonary hypertension of various origins. We present a case of a patient with acute pulmonary hypertension and severely impaired gas exchange following pulmonary thrombo-endarterectomy. Therapy with one inhaled vasodilator alone did not satisfactorily abort a postoperative pulmonary hypertensive crisis and low-output syndrome due to right heart failure. Combined inhaled nitric oxide and inhaled iloprost, however, showed additive effects. Hence, the combination of both drugs may be reasonable in cases where the standard therapy fails. The effect has been demonstrated by means of continuous blood gas monitoring.
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Flondor et al. (2006) studied this question.
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