Inhaled nitric oxide improves pulmonary functions following massive pulmonary embolism

Objectives

Acute pulmonary embolism increases pulmonary resistance and may lead to acute right ventricular failure and cardio circulatory collapse, possibly resulting in substantial morbidity and mortality. Inhaled nitric oxide (NO) dilates pulmonary blood vessels and has been used to reduce pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension and acute respiratory distress syndrome. This case series describes our experience with inhaled NO administered to four patients suffering from acute massive pulmonary embolism following abdominal surgery.

Results

The four described patients were recovering from small bowel resection, pancreatoduodenectomy, hemipelvectomy or recent gastrointestinal bleeding and presented with severe respiratory and hemodynamic deterioration due to pulmonary embolism. Each received inhaled NO (20–25 ppm) via the inspiratory side of the breathing circuit of the ventilator. Pulmonary and systemic blood pressures, heart rate and gas exchange levels improved in all the patients within minutes after the initiation of NO administration.

Conclusions

Inhaled NO may be useful in treating acute massive pulmonary embolism. This potential application warrants further investigation.