Inhaled Nitric Oxide Therapy Case Study 2022

Running head: INHALED NITRIC OXIDE THERAPY 1
Inhaled Nitric Oxide Therapy
Name
Institutional Affiliation

INHALED NITRIC OXIDE THERAPY 2
INHALED NITRIC OXIDE THERAPY
Introduction
Pulmonary arterial hypertension (PAH) is one of the most significant health issues in
Australia today, as it is the primary cause of deaths related to systemic sclerosis (Playford et al.
2017). A cohort study by the Pharmaceutical Benefits Scheme (2018) conducted from 2011 to
2016 showed that, among the 3,500 registered cases of PAH from the PH Society of Australia
and New Zealand Registry, approximately 45.50 percent have succumbed, with the average
survival duration from the diagnosis time of 3.70 years.
The case study involves a 63-year-old male patient with PAH moved to the ICU from the
rehabilitation hospital. He has hypoxia, hypotension, and tachycardia. Due to the condition of the
patient, the iNO therapy use in ICU was required to restore optimal functioning. This essay will
analyse a case study of a patient with PAH, focusing on the administration of iNO therapy, and
will include a literature review of iNO therapy.
PMH, Reason for Requiring ICU Admission and Current Interventions
The 63-year-old male patient was admitted from a rehabilitation hospital to the ICU after
having a multiple Medical Emergency Calls for hypoxia, hypotension, tachycardia and acute on
chronic type 2 respiratory failure. The patient presented a complex previous medical background,
including severe pulmonary arterial hypertension with moderate right heart dysfunction,
hypersensitivity pneumonitis (extrinsic allergic alveolitis), and interstitial lung disease, which
has been treated with fluctuating dosage of oral Prednisolone therapy and home oxygen. Patient
is currently not suitable for a lung transplantation. On arrival to ICU, the patient has been treated
with inhaled nitric oxide via high flow nasal prong (10ppm).
Pathophysiology Pulmonary Arterial Hypertension

INHALED NITRIC OXIDE THERAPY 3
What is pulmonary hypertension?
Pulmonary hypertension (PH) is a kind of HBP which affects arteries in the lungs and
right-side of the heart by narrowing, blocking or destroying pulmonary arterioles, and capillaries.
Pathophysiology
The pathophysiology of PAH is always never fully identified, however, the two major
mechanisms of PH are increased pulmonary vascular resistance alongside increased pulmonary
venous pressure. The PHTCs (pulmonary hypertensive crises) is lethal events characterized by
quick rise in PVR to the level whereby PAP (pulmonary arterial pressure) surpasses the SBP
(systemic blood pressure) (Karam et al., 2017). The resultant right heart failure culminates in a
reduction in pulmonary blood flow, hypoxia, and reduced cardiac output, alongside biventricular
failure that when not treated lead to rapid cardiovascular collapse and eventually, death. The
following literature review will demonstrate how iNO has been applied to dealing with PH.
Nitric Oxide Therapy
The intervention that will be used to assist the patient in the ICU is iNO via high flow
nasal prolong (10ppm).
What is iNO
It is the use of an endogenous signaling molecule acting in the vascular smooth muscle
(VSM) cells through the guanylate cyclase activation. This triggers the cyclic guanosine
monophosphate (cGMP) formation. The high cGMP level hence set off the phosphorylation cas-
cade, which leads to vasodilation and relaxation of smooth muscle (Haakons, Ireland & Kan-
dasamy, 2019).
Action of iNO