Background Pulmonary hypertension is a hallmark of high-altitudepulmonary edema and may contribute to its pathogenesis. Whenadministered by inhalation, nitric oxide, an endothelium-derivedrelaxing factor, attenuates the pulmonary vasoconstriction producedby short-term hypoxia.
Methods We studied the effects of inhaled nitric oxide on pulmonary-arterypressure and arterial oxygenation in 18 mountaineers prone tohigh-altitude pulmonary edema and 18 mountaineers resistantto this condition in a high-altitude laboratory (altitude, 4559m). We also obtained lung-perfusion scans before and duringnitric oxide inhalation to gain further insight into the mechanismof action of nitric oxide.
Results In the high-altitude laboratory, subjects prone to high-altitudepulmonary edema had more pronounced pulmonary hypertension andhypoxemia than subjects resistant to high-altitude pulmonaryedema. Arterial oxygen saturation was inversely related to theseverity of pulmonary hypertension (r = -0.50, P = 0.002). Insubjects prone to high-altitude pulmonary edema, the inhalationof nitric oxide (40 ppm for 15 minutes) produced a decreasein mean (±SD) systolic pulmonary-artery pressure thatwas three times larger than the decrease in subjects resistantto such edema (25.9±8.9 vs. 8.7±4.8 mm Hg, P<0.001).Inhaled nitric oxide improved arterial oxygenation in the 10subjects who had radiographic evidence of pulmonary edema (arterialoxygen saturation increased from 67±10 to 73±12percent, P = 0.047), whereas it worsened oxygenation in subjectsresistant to high-altitude pulmonary edema. The nitric oxide–inducedimprovement in arterial oxygenation in subjects with high-altitudepulmonary edema was accompanied by a shift in blood flow inthe lung away from edematous segments and toward nonedematoussegments.
Conclusions The inhalation of nitric oxide improves arterialoxygenation in high-altitude pulmonary edema, and this beneficialeffect may be related to its favorable action on the distributionof blood flow in the lungs. A defect in nitric oxide synthesismay contribute to high-altitude pulmonary edema.
Source Information
From the Department of Internal Medicine (U.S., P.N.) and the Division of Cardiology (A.D., M.S.), Centre Hospitalier Universitaire Vaudois, Lausanne; the Institute of Physiology, Lausanne (L.V.); and the Departments of Medicine (G.-R.K., P.E.B.), Radiology (U.E.), and Nuclear Medicine (A.F.), University Hospital, Berne — all in Switzerland; and the Department of Sports Medicine, University of Heidelberg, Heidelberg, Germany (P.B.). Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, November 14–17, 1994, and at the 9th International Hypoxia Symposium at Lake Louise, Alta., Canada, February 14–18, 1995.
Address reprint requests to Dr. Scherrer at the Department of Internal Medicine, BH 10.642, CHUV, 1011 Lausanne, Switzerland.
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