RESUMO
BACKGROUND: Exhaled nitric oxide (NO) concentrations have been suggested as a marker of disease onset and severity in a number of inflammatory conditions such as acute asthma. Known markers of the onset of acute lung injury require invasive tests and laboratory based analysis and have limited clinical applicability. We performed a study of the use of exhaled NO as a marker of developing acute lung injury during and after coronary artery bypass grafting in patients requiring cardiopulmonary bypass. METHODS: Mixed expired air samples were taken from the patient breathing system and analysed for exhaled NO using chemiluminescence analysis. RESULTS: Exhaled nitric oxide concentrations in expired gas correlated with the PaO2/FlO2 ratio (r = 0.23, P < 0.01). There was a non-significant trend towards a reduction in exhaled NO levels from after induction of anaesthesia to post-bypass time points, with the lowest exhaled NO concentrations occurring at this time (P = 0.07). There was no correlation between mean arterial pressure (r = -0.1, P = 0.54) or mean pulmonary artery pressure (r = -0.1. P = 0.67) and expired NO levels. CONCLUSIONS: Further work is required to test whether exhaled NO concentration may be useful in diagnosing the onset of acute lung injury in patients undergoing coronary artery bypass grafting.
Assuntos
Ponte de Artéria Coronária , Óxido Nítrico/análise , Síndrome do Desconforto Respiratório/diagnóstico , Biomarcadores/análise , Testes Respiratórios , Humanos , Oxigênio/fisiologia , Pressão ParcialRESUMO
OBJECTIVE: Although unlicensed, inhaled nitric oxide (NO) therapy is now widely used in the United Kingdom. Our aim was to produce guidelines for the clinical application of inhaled NO in adult intensive care practice, based upon the current level of published information. METHODS: The published data regarding the use of inhaled NO in the acute respiratory distress syndrome and right-sided cardiac failure was presented, analysed and discussed. Recommendations based on these data as well as on current experience in the United Kingdom were formulated. DESIGN: An expert group comprising intensive care specialists from within the United Kingdom, representatives from the European Society of Intensive Care Medicine and the Society of Critical Care Medicine and individuals from the Departments of Health and Industry related to the field was assembled. RESULTS: United Kingdom guidelines for the indications, contraindications, dose, delivery, monitoring and scavenging of inhaled NO therapy were produced. CONCLUSIONS: The need for additional quality research to establish evidence of efficacy and safety was emphasized. The guidelines are designed to act within the context of current practice and knowledge and should be revised as further data emerge.
Assuntos
Cuidados Críticos/normas , Lesão Pulmonar , Óxido Nítrico/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Medicamentos para o Sistema Respiratório/uso terapêutico , Doença Aguda , Administração por Inalação , Adulto , Parada Cardíaca/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva , Óxido Nítrico/administração & dosagem , Medicamentos para o Sistema Respiratório/administração & dosagem , Reino UnidoRESUMO
Flumazenil rapidly and effectively terminates the actions of benzodiazepines by competitive antagonism at specific benzodiazepine receptors in the central nervous system. This article describes the pharmacology of flumazenil and reviews the indications for its use and the adverse effects which may follow its administration.
