Wednesday, November 12, 2014

Q: Why inhaled intrinsic Nitric oxide should always be weaned instead of abrupt discontinuation

Answer:  Abrupt discontinuation of inhaled NO may cause severe rebound pulmonary hypertension, an increase in intrapulmonary right-to-left shunting, and a decreased PaO2.

Exact mechanism is not known but It has been suggested that downregulation of endogenous NO synthesis and/or elevated endothelin-1 levels by inhaled NO is probably responsible for this rebound.

Slow stepwise weaning of the inhaled NO concentration is recommended.


1. Rossaint R, Falke KJ, Lopez F, et al. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med. 1993; 328: 399–405.

2. Black SM, Heidersbach RS, McMullan DM, et al. Inhaled nitric oxide inhibits NOS activity in lambs: potential mechanism for rebound pulmonary hypertension. Am J Physiol Heart Circ Physiol. 1999; 277: H1849–H1856.

3. McMullan DM, Bekker JM, Johengen MJ, et al. Inhaled nitric oxide-induced rebound pulmonary hypertension: role for endothelin-1. Am J Physiol Heart Circ Physiol. 2001; 280: H777–H785.

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