Deterioration of PaO₂ with reduction of pulmonary artery pressure following nitric oxide (NO) inhalation in a patient with septic acute respiratory distress syndrome (ARDS)

Abstract

We report on a patient with acute respiratory distress syndrome (ARDS) whose PaO₂ had deteriorated during nitric oxide (NO) inhalation while pulmonary arterial pressure decreased. A 70-year-old man developed septic shock and ARDS due to bacterial pneumonia. Noradrenaline and dopamine were intravenously administered for circulatory support, with administration of antibiotics, steroid and urinastatin. During 10ppm NO inhalation, mean pulmonary arterial pressure decreased from 23 to 20mmHg and PaO₂ decreased from 54.8 (F_IO₂=1.0) to 49.2 (F_IO₂=0.96)mmHg. Mean arterial pressure increased, with the cardiac index, pulmonary artery wedge pressure and pulmonary capillary pressure remaining unchanged. PaO₂ increased following discontinuation of NO. Our findings suggest that inhalation of NO may occasionally induce deterioration of oxygenation in patients with septic ARDS while decreasing pulmonary arterial pressure.