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How does NO act at cellular levels?
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The Use of Nitric Oxide in Intensive Care Ventilation
Wassim Sukari, M.D.
Occurrence of NO in the Body
Vaso-m uscu la ture
B lood ce lls
M acrophages
M em ory
N O
How does NO act at cellular levels?
Metabolism of NO in the Body
Potential Uses of NO
PF C PPH N
H eart fa ilure
N eonates
H ear fa ilure
C hildren
H eart fa ilure ALI A R D S
C O PD
Adults
N O
Circulation in Adults
Circulation in the foetus
Effects of vascular regulation on blood flow and its distribution in lung and body circulation depending
on are affected
C hange in d istributionof b lood flow
For s inglr organswithin the lung
C hange inblood pressure
For a ll organsfor the whole lung
Vascular regulationchange in resistance
Vaso-constriction and Vaso-dilation in Alveoli
Direct and Indirect Consequences of Hypoxia
Organ failure
Inadequateoxygen supply
Pulm onaryhypertension
Increase inpulm anary vascular
resistance
Hypoxia
Direct and Indirect Consequences of Pulmonary Hypertension
Heart failure
Increased afterloadon right ventricle
Lungoedem a
Increase infiltration pressure
in the lung
Hypoxia
Reversal ofintra- or extra-cardial shunt
Pulm oanaryhypertension
Comparison Between Inhaled NO and Infused Vasodilators
NO Infused vaso-dilator
PaO2
Shunt
MPAP
MAP
Risks of NO Inhalation
NO, NO2, NO3 Cell toxicityMutagenesis
HNO2, HNO3 OedemaIncreased airway resistance
MetHb Internal asphyxia
Displacement of oxygen Oxygen shortage
Influence on blood clotting Haemorrhage
Influence on endogenousNO production
Rebound effects
Diagram of Ventilation with NO Flow Control
Components of NOdomo
Effects of NO Inhalation on Ventilation
Increase inpressure
Volum e controolledventilatore
Pressure levelis achieved
m ore rapidly
Pressure controlledventilators
D ilution ofinspiratory oxygen
concentration
General
NO supply
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