Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion

• Published in: Acta anaesthesiologica Scandinavica Vol. 49; no. 3; pp. 415 - 417
• Main Authors: Meaudre, E., Goutorbe, P., Boret, H., Kaiser, E., Salinier, L., Cantais, E., Palmier, B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Publishing Ltd/Inc 01-03-2005; Blackwell
• Subjects: Accidents, Traffic; Administration, Inhalation; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - therapeutic use; Catecholamines - therapeutic use; Contusions - complications; Contusions - drug therapy; Contusions - etiology; Dose-Response Relationship, Drug; Electrocardiography - methods; Epinephrine - therapeutic use; Fatal Outcome; Head Injuries, Closed - etiology; Heart Injuries - complications; Heart Injuries - drug therapy; Heart Injuries - etiology; Hemodynamics - drug effects; Humans; Male; Management; Medical sciences; myocardial contusion; nitric oxide; Nitric Oxide - administration & dosage; Nitric Oxide - therapeutic use; Norepinephrine - therapeutic use; Respiratory Distress Syndrome, Adult - complications; right ventricle; Vasoconstrictor Agents - therapeutic use; ventricular dysfunction; Ventricular Dysfunction, Right - drug therapy; Ventricular Dysfunction, Right - etiology; Wounds, Nonpenetrating - complications; Right ventricle; Cardiovascular disease; Contusion; Heart ventricle; Right ventricular failure; ventricular dysfunction; Management; Inhalation; myocardial contusion; Clinical management; Heart disease; Nitric oxide; Anesthesia
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2005.00644.x

We report a severe head injury and blunt chest trauma with sternal and multiple rib fractures with high‐energy impact in a 22‐year‐old man. Twelve hours after the accident, haemodynamic status of the patient rapidly worsened because of right ventricular (RV) failure due to myocardial contusion, requiring increasing doses of catecholamine. Nitric oxide inhalation was used to decrease RV afterload, and produced an immediate improvement in haemodynamic status, permitting a decrease in catecholamine administration. From days 2 through 8, cardiac function continued to improve, and was normal on day 9. Nitric oxide inhalation was stopped on day 4.