Abstract
An unconscious 75-year-old man in state of shock was admitted to our ICU. He had undergone a resection of a brain tumor two months previously. Acute pulmonary thromboembolism was diagnosed based on the following: hypoxia, increased pulmonary arterial pressure, right bundle branch block on electrocardiography, and perfusion defect on pulmonary perfusion scintigram. In spite of mechanical ventilation and intravenous administration of nasaruplase and low-molecular-weight heparin, his pulmonary oxygenation did not improve and inhalation therapy with nitric oxide (NO; 5ppm) was started. The PaO2/FIO2 ratio (P/F) increased from 164 to 194 after NO inhalation, but decreased to about 90 by 30 minutes after the cessation of NO inhalation. Mean pulmonary arterial pressure and pulmonary vascular resistance decreased during NO inhalation. These results suggest that inhaled NO was effective for the improvement of pulmonary oxygenation and pulmonary hypertension in a patient with acute massive pulmonary thromboembolism.
