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(Circulation. 1998;98:2441-2445.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Effects of Inhaled Nitric Oxide and Oxygen in High-Altitude Pulmonary Edema

Presented in part at the at 70th Scientific Sessions of the American Heart Association, Orlando, Fla, November 9–12, 1997.

Inder S. Anand, MD, DPhil, FRCP; B. A. K. Prasad, MD; Sumeet S. Chugh, MD; K. R. M. Rao, MD, DM; David N. Cornfield, MD; Carlos E. Milla, MD; Navneet Singh, MB, BS; Surjit Singh, MB, BS; ; William Selvamurthy, PhD

From the VA Medical Center and University of Minnesota, Minneapolis (I.S.A., S.S.C, D.N.C., C.E.M.); High Altitude Medical Research Center, Leh, Ladakh, India (B.A.K.P., K.R.M.R., N.S., S.S.); and the Defense Institute of Physiology and Allied Sciences, Delhi, India (W.S.).

Correspondence to Inder S. Anand, MD, DPhil, FRCP, Professor of Medicine, Department of Cardiology, VA Medical Center 111C, Minneapolis, MN 55417. E-mail anand001{at}maroon.tc.umn.edu

Background—High-altitude pulmonary edema (HAPE) is characterized by pulmonary hypertension, increased pulmonary capillary permeability, and hypoxemia. Treatment is limited to descent to lower altitude and administration of oxygen.

Methods and Results—We studied the acute effects of inhaled nitric oxide (NO), 50% oxygen, and a mixture of NO plus 50% oxygen on hemodynamics and gas exchange in 14 patients with HAPE. Each gas mixture was given in random order for 30 minutes followed by 30 minutes washout with room air. All patients had severe HAPE as judged by Lake Louise score (6.4±0.7), PaO₂ (35±3.1 mm Hg), and alveolar to arterial oxygen tension difference (AaDO₂) (26±3 mm Hg). NO had a selective effect on the pulmonary vasculature and did not alter systemic hemodynamics. Compared with room air, pulmonary vascular resistance fell 36% with NO (P<0.001), 23% with oxygen (P<0.001 versus air, P<0.05 versus NO alone), and 54% with NO plus 50% oxygen (P<0.001 versus air, P<0.005 versus oxygen and versus NO). NO alone improved PaO₂ (+14%) and AaDO₂ (-31%). Compared with 50% oxygen alone, NO plus 50% oxygen had a greater effect on AaDO₂ (-18%) and PaO₂ (+21%).

Conclusions—Inhaled NO may have a therapeutic role in the management of HAPE. The combined use of inhaled NO and oxygen has additive effects on pulmonary hemodynamics and even greater effects on gas exchange. These findings indicate that oxygen and NO may act on separate but interactive mechanisms in the pulmonary vasculature.

Key Words: hypoxia • edema • pulmonary heart disease • hypertension • nitric oxide

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