iNO as Salvage Treatment of Hypoxemia After TAAD Surgery
- Conditions
- Type A Aortic Dissection
- Interventions
- Drug: inhaled nitric oxideDevice: PEEP
- Registration Number
- NCT04032366
- Lead Sponsor
- Shanghai Zhongshan Hospital
- Brief Summary
The purpose of this study was to clarify the possible mechanism of hypoxemia after surgical treatment of type A acute aortic dissection and the possible mechanism of the treatment role of inhaled nitric oxide in refractory hypoxemia.
- Detailed Description
The investigators' previous study has stressed that inhaled nitric oxide therapy might play an ameliorative role in patients with refractory hypoxemia after surgical treatment of type A acute aortic dissection. The possible reason might be the decreasing of intrapulmonary shunt because previous studies showed that inhaled nitric oxide could decrease intrapulmonary shunt by selectively dilating the pulmonary vessels in ventilated areas. As a result, the investigators designed this observational study to calculate the intrapulmonary shunt before and after inhaled nitric oxide therapy. Intrapulmonary shunt was calculated from oxygen content (CO2) of different sites ( artery, mixed venous, alveolar capillary) by Fick equation:(CaO2-CcO2)/(CvO2-CcO2). A FiO2 of 1.0 and tidal volume of 6\~8 ml/kg were chosen. Oxygen content was calculated from hemoglobin (Hb), oxygen saturation (SO2) and oxygen partial pressure (PO2) by the following equation: CO2 = 1.34\*Hb\*SO2 + 0,0031\*PO2. PaO2, SaO2, PvO2 and SvO2 were measured from arterial and mixed venous blood samples taken from the radial arterial catheter and from the pulmonary artery catheter. ScO2 was estimated to be 1.0 with a FiO2 of 100%. PcO2 was considered to be the same as PAO2 (partial pressure of oxygen in the alveoli), and was calculated from the alveolar gas equation with PAO2 = \[(atmospheric pressure - 47) \* (FiO2)\] - PaCO2/0.8.Other variables such as hemodynamic variables from pulmonary artery catheter were also collected.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 20
- Adult
- Type A aortic dissection;
- After surgery;
- P/F ratio ≤ 200mmHg
- Intracardiac shunt;
- Contradiction of PAC;
- Chronic pulmonary diseases before surgery;
- ECMO;
- Anticipation of death within 48 hours after operation;
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description PEEP 10 PEEP post-surgical type A acute aortic dissection patients was ventilated with a PEEP of 10cm H2O, without inhaled nitric oxide PEEP 10 inhaled nitric oxide post-surgical type A acute aortic dissection patients was ventilated with a PEEP of 10cm H2O, without inhaled nitric oxide PEEP 5 +iNO inhaled nitric oxide post-surgical type A acute aortic dissection patients was ventilated with a PEEP of 5cm H2O, with inhaled nitric oxide PEEP 5 +iNO PEEP post-surgical type A acute aortic dissection patients was ventilated with a PEEP of 5cm H2O, with inhaled nitric oxide
- Primary Outcome Measures
Name Time Method Intrapulmonary shunt with a PEEP of 5 cm H2O 6 to 24 hours after surgery intrapulmonary shunt calculated by Fick equation with a PEEP of 5 cm H2O
Intrapulmonary shunt with a PEEP of 10 cm H2O 30 minutes after increasing PEEP to 10cm H2O intrapulmonary shunt calculated by Fick equation with a PEEP of 10 cm H2O
Intrapulmonary shunt with inhaled nitric oxide and a PEEP of 5 cm H2O 30 minutes after decreasing PEEP to 5cm H2O intrapulmonary shunt calculated by Fick equation with inhaled nitric oxide and a PEEP of 5 cm H2O
Intrapulmonary shunt with a PEEP of 10 cm H2O and inhaled nitric oxide 30 minutes after inhaling nitric oxide intrapulmonary shunt calculated by Fick equation with a PEEP of 10 cm H2O and inhaled nitric oxide
- Secondary Outcome Measures
Name Time Method cardiac output collected from PAC with a PEEP of 10cm H2O 30 minutes after increasing PEEP to 10cm H2O cardiac output in L/min
cardiac output collected from PAC with a PEEP of 5 cm H2O 6 to 24 hours after surgery cardiac output in L/min
pulmonary artery pressure collected from PAC with a PEEP of 5 cm H2O 6 to 24 hours after surgery pulmonary artery pressure in mmHg
pulmonary artery wedge pressure collected from PAC with a PEEP of 5 cm H2O 6 to 24 hours after surgery pulmonary artery wedge pressure in mmHg
pulmonary artery wedge pressure collected from PAC with a PEEP of 10 cm H2O and inhaled nitric oxide 30 minutes after inhaling nitric oxide pulmonary artery wedge pressure in mmHg
pulmonary artery pressure collected from PAC with inhaled nitric oxide and a PEEP of 5 cm H2O 30 minutes after decreasing PEEP to 5 cm H2O pulmonary artery pressure in mmHg
pulmonary artery wedge pressure collected from PAC with inhaled nitric oxide and a PEEP of 5 cm H2O 30 minutes after decreasing PEEP to 5 cm H2O pulmonary artery wedge pressure in mmHg, etc
pulmonary artery wedge pressure collected from PAC with a PEEP of 10 cm H2O 30 minutes after increasing PEEP to 10cm H2O pulmonary artery wedge pressure in mmHg
cardiac output collected from PAC with a PEEP of 10 cm H2O and inhaled nitric oxide 30 minutes after inhaling nitric oxide cardiac output in L/min
cardiac output collected from PAC with inhaled nitric oxide and a PEEP of 5 cm H2O 30 minutes after decreasing PEEP to 5 cm H2O cardiac output in L/min
pulmonary artery pressure collected from PAC with a PEEP of 10 cm H2O 30 minutes after increasing PEEP to 10cm H2O pulmonary artery pressure in mmHg
pulmonary artery pressure collected from PAC with a PEEP of 10 cm H2O and inhaled nitric oxide 30 minutes after inhaling nitric oxide pulmonary artery pressure in mmHg
Trial Locations
- Locations (1)
Zhongshan hospital Fudan University
🇨🇳Shanghai, Shanghai, China