This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200310-1483OCv1 170/9/1006    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mourani, P. M. Articles by Abman, S. H. Search for Related Content PubMed PubMed Citation Articles by Mourani, P. M. Articles by Abman, S. H.

Pulmonary Vascular Effects of Inhaled Nitric Oxide and Oxygen Tension in Bronchopulmonary Dysplasia

Divisions of Critical Care, Cardiology, and Pulmonary Medicine, The Pediatric Heart-Lung Center, Department of Pediatrics, The Children's Hospital and University of Colorado Health Sciences Center, Denver, Colorado

Correspondence and requests for reprints should be addressed to Peter M. Mourani, M.D., Department of Pediatrics, Division of Critical Care, The Children's Hospital, 1056 East 19th Avenue B530, Denver, CO 80218. E-mail: Peter.Mourani{at}UCHSC.edu

Pulmonary hypertension contributes significantly to morbidity and mortality in bronchopulmonary dysplasia (BPD), but little is known about the relative contribution of arterial tone, structural remodeling, and vessel density to pulmonary hypertension, especially in older patients. To determine the role of high pulmonary vascular tone in pulmonary hypertension, we studied the acute effects of oxygen tension, inhaled nitric oxide (iNO), and calcium channel blockers (CCB) in 10 patients with BPD who underwent cardiac catheterization for evaluation of pulmonary hypertension. During normoxic conditions, mean pulmonary arterial pressure (PAP) and pulmonary to systemic vascular resistance ratio (PVR/SVR) were 34 ± 3 mm Hg and 0.42 ± 0.07, respectively. In response to hypoxia, PAP and PVR/SVR increased by 50 ± 8% and 82 ± 14%, respectively (p < 0.01). Hyperoxia decreased PVR/SVR by 28 ± 9% (p = 0.05). The addition of iNO treatment (20–40 ppm) to hyperoxia decreased PAP and PVR/SVR by 29 ± 5% (p < 0.01) and 45 ± 6% (p < 0.05) from baseline values, respectively, achieving near normal values. CCB did not alter PAP or PVR/SVR from baseline values. We conclude that hyperoxia plus iNO causes marked pulmonary vasodilatation in older patients with BPD, suggesting that heightened pulmonary vascular tone contributes to pulmonary vascular disease in BPD.

Key Words: bronchopulmonary dysplasia • cardiac catheterization • nitric oxide • pulmonary hypertension • pulmonary vascular reactivity

This article has been cited by other articles:

				R. L. Jones, A. W. Sheel, R. Naeije, J. M. B. Hughes, and M. L. Bates Pathophysiological insight into shunted bubbles. J Appl Physiol, September 1, 2009; 107(3): 999 - 1000. [Full Text] [PDF]

				K. Woyda, S. Koebrich, I. Reiss, S. Rudloff, S. S. Pullamsetti, A. Ruhlmann, N. Weissmann, H. A. Ghofrani, A. Gunther, W. Seeger, et al. Inhibition of phosphodiesterase 4 enhances lung alveolarisation in neonatal mice exposed to hyperoxia Eur. Respir. J., April 1, 2009; 33(4): 861 - 870. [Abstract] [Full Text] [PDF]

				G. J. Rey-Parra, S. L. Archer, R. D. Bland, K. H. Albertine, D. P. Carlton, S.-C. Cho, B. Kirby, A. Haromy, F. Eaton, X. Wu, et al. Blunted Hypoxic Pulmonary Vasoconstriction in Experimental Neonatal Chronic Lung Disease Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 399 - 406. [Abstract] [Full Text] [PDF]

				P. M. Mourani, M. K. Sontag, A. Younoszai, D. D. Ivy, and S. H. Abman Clinical Utility of Echocardiography for the Diagnosis and Management of Pulmonary Vascular Disease in Young Children With Chronic Lung Disease Pediatrics, February 1, 2008; 121(2): 317 - 325. [Abstract] [Full Text] [PDF]

				E. Khemani, D. B. McElhinney, L. Rhein, O. Andrade, R. V. Lacro, K. C. Thomas, and M. P. Mullen Pulmonary Artery Hypertension in Formerly Premature Infants With Bronchopulmonary Dysplasia: Clinical Features and Outcomes in the Surfactant Era Pediatrics, December 1, 2007; 120(6): 1260 - 1269. [Abstract] [Full Text] [PDF]

				B. Thebaud and S. H. Abman Bronchopulmonary Dysplasia: Where Have All the Vessels Gone? Roles of Angiogenic Growth Factors in Chronic Lung Disease Am. J. Respir. Crit. Care Med., May 15, 2007; 175(10): 978 - 985. [Abstract] [Full Text] [PDF]

				R. D. Bland, K. H. Albertine, D. P. Carlton, and A. J. MacRitchie Inhaled Nitric Oxide Effects on Lung Structure and Function in Chronically Ventilated Preterm Lambs Am. J. Respir. Crit. Care Med., October 1, 2005; 172(7): 899 - 906. [Abstract] [Full Text] [PDF]

				F. Ladha, S. Bonnet, F. Eaton, K. Hashimoto, G. Korbutt, and B. Thebaud Sildenafil Improves Alveolar Growth and Pulmonary Hypertension in Hyperoxia-induced Lung Injury Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 750 - 756. [Abstract] [Full Text] [PDF]

				A. Bush, F. Accurso, W. MacNee, S. C. Lazarus, and E. Abraham Cystic Fibrosis, Pediatrics, Control of Breathing, Pulmonary Physiology and Anatomy, and Surfactant Biology in AJRCCM in 2004 Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 545 - 553. [Full Text] [PDF]