INHALED NITRIC OXIDE FOR TREATMENT OF NEONATAL & ADULT PULMONARY HYPE

本研究的目的是获得对常规治疗无效的重症肺动脉高压患者应用一氧化氮(NO)的经验，并制定预测患者从吸入NO中获益的可能性的标准。接受NO治疗的患者将依赖呼吸机。由于NO在空气或氧气中不稳定，因此必须将其添加到吸入的气体中，使其在吸入之前只与空气接触几秒钟。将NO吸入到吸气气体的过程自然会受到呼吸器、通风模式和通过呼吸器的总气流的机械性能的影响。此外，机械通气的行为会影响患者的肺和血流动力学生理学。根据预测不同机械通气模式对肺和血流动力学的影响以及患者的个体病理生理，为患者选择不同的机械通气模式。吸入气体中添加NO可能会影响患者对各种呼吸模式的反应。这项研究将以患者为自身对照，纵向研究，只考虑NO是否能有效降低肺动脉压，或重新分配肺血流量，从而改善动脉血氧饱和度和/或减少肺分流。吸入NO的疗效将与患者疾病的性质和严重程度、患者正在接受的呼吸支持的类型以及患者正在接受的伴随治疗相关。

The purpose of this study is to gain experience in administering nitric oxide (NO) to patients with critical pulmonary hypertension resistant to conventional therapy, and to develop criteria for predicting the likelihood of a patient deriving benefit from inhaled NO. Patients who will receive NO will be ventilator-dependent. Since NO in unstable in air or oxygen, it must be added to the inspired gas at a point where it is in contact with air for only a few seconds before being inhaled. The process of administering the NO to the inspiratory gas will naturally be affected by the ventilator, the mode of ventilation, and the mechanics of the total gas flow through the ventilator. Additionally, the act of mechanical ventilation will affect the pulmonary and hemodynamic physiology of the patient. Different modes of mechanical ventilation are selected in individual patients based on predicting pulmonary and hemodynamic effects of that mode of ventilation and the patients' individual pathophysiology. Addition of NO to the inspired gases may have an impact upon the patients' response to various modes of ventilation. This investigation will use patients as their own controls in a longitudinal fashion and will consider only whether NO is effective in lowering the pulmonary artery pressure, or in redistribution pulmonary blood flow so that arterial oxygen saturation is improved and/or pulmonary shunt decreased. Efficacy of inhaled NO will be correlated with the nature and severity of the patient's disease, the type of respiratory support the patient is receiving, and whatever concomitant therapy the patient is receiving.