Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension

INTRODUCTION: The use of low-dose dobutamine to maintain hemodynamic stability in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO), dobutamine and a combination of the two have beneficial effects in patients with end-stage airway lung disease and pulmonary hypertension. METHOD: Hemodynamic evaluation was assessed 10 min after the administration of each drug and of their combination, in 28 candidates for lung transplantation. RESULTS: Administration of INO caused a reduction in mean pulmonary arterial pressure (MPAP), an increase in PaO(2) with a significant reduction in venous admixture effect (Q(s)/Q(t)).Dobutamine administration caused an increase in cardiac index and MPAP, with a decrease in PaO(2) as a result of a higher Q(s)/Q(t). Administration of a combination of the two drugs caused an increase in the cardiac index without MPAP modification and an increase in PaO(2) and Q(s)/Q(t). CONCLUSION: Dobutamine and INO have complementary effects on pulmonary circulation. Their association may be beneficial in the treatment of patients with mild to moderate pulmonary hypertension.