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CARDIOVASCULAR ANESTHESIA

Small-Dose Nitric Oxide Improves Oxygenation During One-Lung Ventilation: An Experimental Study

Jochen Sticher, MD^*, Stefan Scholz, MD^*, Olav Böning, MD^*, Ralph Theo Schermuly, PhD, Claudia Schumacher^*, Dieter Walmrath, MD, and Gunter Hempelmann, MD^*

Departments of *Anaesthesiology and Intensive Care Medicine and Internal Medicine, Justus-Liebig University, Giessen, Germany

Address correspondence and reprint requests to Stefan Scholz, MD, Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany. Address e-mail to resp36{at}aol.com

Inhaled nitric oxide (NO) at 20 or 40 ppm does not improve arterial oxygenation during one-lung ventilation (OLV). The authors hypothesized that NO at smaller concentrations might improve oxygenation. Twelve piglets weighing 26 to 32 kg were studied. When PaO₂ had reached a plateau during OLV, NO at doses of 4, 8, 16, and 32 ppm were randomly administered for 30 min. Hemodynamic data were determined by invasive monitoring. Blood gas analysis and, in six animals, ventilation-perfusion analysis by the multiple inert gas elimination technique were used to characterize pulmonary gas exchange. NO at 4, 8, 16, and 32 ppm improved PaO₂ during OLV. NO at 4 ppm had a more intense effect on arterial oxygenation than doses of 8, 16, and 32 ppm (PaO₂, 42 ± 35 mm Hg versus 22 ± 20 mm Hg, 13 ± 18 mm Hg, and 15 ± 16 mm Hg; P < 0.05). NO at 4 ppm reduced intrapulmonary shunt flow, whereas a larger concentration exhibited no statistically significant effect. The authors conclude that NO improves arterial oxygenation more effectively at smaller doses than at larger doses. This dose-dependent effect remains to be confirmed in acute hypoxemia during OLV.

IMPLICATIONS: Inhaled nitric oxide at 4 ppm improves arterial oxygenation during one-lung ventilation to a greater extent than larger doses, and this effect is caused by a reduction in intrapulmonary shunt.

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