scholarly journals The Impact of Combined Oral Sildenafil and Inhaled Nitric Oxide for Treating Persistent Pulmonary Hypertension of the Newborn: A Single Center Experience

2017 ◽  
Vol 23 (2) ◽  
pp. 100
Author(s):  
Hayriye Gozde Kanmaz ◽  
Mehmet Büyüktiryaki ◽  
Şerife Suna Oğuz ◽  
Evrim Dizdar Alyamac ◽  
Fatma Nur Sarı ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Therapy Group ◽  
Combined Therapy ◽  
Newborn Infants ◽  
Inhaled Nitric Oxide ◽  
Single Center Experience ◽  
Group I ◽  
Nitric Oxide Therapy ◽  
The Impact

<p><strong>Objective:</strong> We aimed to compare the effect of the combined therapy, sildenafil and inhaled nitric oxide with inhaled nitric oxide monotherapy for the treatment of Pulmonary Hypertension of the Newborn.</p><p><strong>Study Design:</strong> Newborn infants (gestational age greater than 34 weeks) who were diagnosed with pulmonary hypertension between December 2008 and 2010 were retrospectively evaluated. Group I (n=14) received monotherapy with inhaled nitric oxide and Group II (n=9) received combined therapy with inhaled nitric oxide and oral sildenafil. Primary outcome was to compare the duration of inhaled nitric oxide therapy between groups.</p><p><strong>Results:</strong> Demographic characteristics were similar between the groups. Combination therapy was associated with early weaning of inhaled nitric oxide (4.8±1.5 vs. 13.5±7.6 hours). The duration of inhaled nitric oxide therapy was slightly shorter in combined therapy group (75[24-125] vs. 109[24-210] hours), however, the difference was insignificant (p=0.2). The incidence of mortality and neonatal outcomes were similar between the groups (p&gt;0.05).</p><p><strong>Conclusion:</strong> Combined therapy did not result in shorter duration of inhaled nitric oxide therapy. Further well designed and larger studies that will elucidate the benefits of combination therapies and optimal therapy whereinhaled nitric oxide is not available are warranted.</p>

scholarly journals SOD and inhaled nitric oxide normalize phosphodiesterase 5 expression and activity in neonatal lambs with persistent pulmonary hypertension

2010 ◽  
Vol 299 (1) ◽  
pp. L109-L116 ◽  
Author(s):  
Kathryn N. Farrow ◽  
Satyan Lakshminrusimha ◽  
Lyubov Czech ◽  
Beezly S. Groh ◽  
Sylvia F. Gugino ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Soluble Guanylate Cyclase ◽  
Pulmonary Arteries ◽  
Newborn Infants ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
The Impact ◽  
Phosphodiesterase 5 ◽  
Expression And Activity

Phosphodiesterase 5 (PDE5) and soluble guanylate cyclase (sGC) are key regulators of cGMP and pulmonary vascular tone. We sought to determine the impact of mechanical ventilation with O2 with or without inhaled nitric oxide (iNO) or recombinant human Cu/Zn SOD (rhSOD) on sGC, PDE5, and cGMP in the ovine ductal ligation model of persistent pulmonary hypertension of the newborn (PPHN). PPHN lambs were ventilated with 100% O2 for 24 h alone or combined with either inhalation of 20 parts per million (ppm) iNO continuously or a single intratracheal dose of rhSOD (5 mg/kg). Ventilated PPHN lambs were compared with PPHN fetuses, control fetuses, and 1-day-old spontaneously breathing lambs (1DSB). In the small pulmonary arteries of 1DSB lambs, sGC expression increased, PDE5 expression decreased, and cGMP concentrations increased relative to fetal levels. In PPHN lambs ventilated with 100% O2, sGC activity increased to levels comparable with 1DSB levels. However, PDE5 expression and activity increased, and cGMP levels remained at fetal levels. Addition of either iNO or rhSOD decreased PDE5 expression and activity in PPHN lambs and increased cGMP levels to levels comparable with 1DSB lambs. These data suggest that ventilation of PPHN lambs with 100% O2 impairs cGMP-mediated vasodilation in part due to increased PDE5 expression and activity. The addition of either iNO or rhSOD normalized PDE5 and cGMP levels. Thus therapies designed to decrease PDE5 and increase cGMP, such as iNO and rhSOD, may prove useful in the treatment of PPHN in newborn infants.

The effect of inhaled nitric oxide therapy on thromboelastogram in newborns with persistent pulmonary hypertension

2014 ◽  
Vol 173 (10) ◽  
pp. 1381-1385 ◽  
Author(s):  
Sema Tanriverdi ◽  
Ozge Altun Koroglu ◽  
Ozgun Uygur ◽  
Can Balkan ◽  
Mehmet Yalaz ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Nitric Oxide Therapy

scholarly journals Update on the Use of Inhaled Nitric Oxide

1996 ◽  
Vol 3 (6) ◽  
pp. 373-376 ◽  
Author(s):  
Robert M Kacmarek
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Inhaled Nitric Oxide ◽  
Pulmonary Vasculature ◽  
Vascular Effects ◽  
The Past ◽  
Chronic Pulmonary Hypertension ◽  
Transplant Candidates ◽  
Nitric Oxide Therapy ◽  
Rapid Binding

A literature review on nitric oxide would identify thousands of citations on the biological implications of this molecule. From the perspective of respiratory care, the effect inhaled nitric oxide has on pulmonary vasculature is the most intriguing. Over the past five years inhaled nitric oxide has been shown to be useful in the management of oxygenation during acute respiratory distress syndrome, alternation of pulmonary vascular tone in persistent pulmonary hypertension in the newborn, and in the management of chronic pulmonary hypertension in both heart and lung transplant candidates, as well as other potential clinical uses. The key physioligical response is vasodilation of pulmonary vessels in communication with well ventilated lung units and the absence of systemic vascular effects by rapid binding to hemoglobin. Nitric oxide therapy is considered experimental. A delivery system is not commercially available. This has resulted in the development of makeshift delivery systems, many of which may have the potential for adverse effects.

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