Korean J Anesthesiol.  2000 Mar;38(3):457-462. 10.4097/kjae.2000.38.3.457.

Rebound Pulmonary Hypertension after Inhaled Nitric Oxide Withdrawal in Postoperative Congenital Heart Disease

• Kim JH
• Park HK
• Lim YT
• Chang YJ
• Lee KC
• Park JC
• Lee HW
• Park KY
• Cho YL

• KMID: 2237284
• DOI: http://doi.org/10.4097/kjae.2000.38.3.457

Abstract

BACKGROUND: Inhaled nitric oxide (NO) therapy causes selective pulmonary vasodilation in patients with pulmonary hypertension. However, attempts to discontinue inhaled NO may be complicated by abrupt life-threatening rebound pulmonary hypertension (RPH). The purpose of this study was to determine the risk factors to develop RPH and to present the adequate weaning methods.
METHODS
We studied 19 consecutive children who were treated with inhaled NO because of pulmonary hypertension after surgery for congenital heart disease. We compared the dose of NO at the time of start and withdrawal, the duration of weaning and treatment, hemodynamic data, and blood gas analysis before inhaled nitric oxide withdrawal, between patients without (group I, n = 13) and with RPH (group II, n = 6).
RESULTS
Compared with group I, group II patients were older in age (1204 1688 versus 546 1654 days, P < 0.05), had a lower NO concentration just before withdrawal (3 +/- 1.6 versus 5 +/- 2.6 ppm, P <0.05), a shorter duration of NO weaning period (4 +/- 3.3 versus 15 +/- 13.4 hours, P < 0.05) and received NO therapy for a shorter duration (26 +/- 11.6 versus 57 +/- 46.0 hours, P < 0.05).
CONCLUSIONS
We recommend a progressive withdrawal of inhaled nitric oxide to avoid life-threatening RPH observed in the sudden discontinuation.

Keyword

Drugs: nitric oxide; Hypertension: pulmonary hypertension; rebound

MeSH Terms

Blood Gas Analysis
Child
Heart Defects, Congenital*
Hemodynamics
Humans
Hypertension, Pulmonary*
Nitric Oxide*
Risk Factors
Vasodilation
Weaning
Nitric Oxide