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March 11, 1996

Inhaled Nitric Oxide Is Unlikely to Have Contributed to the Death of a Young Woman Suffering From Primary Pulmonary Hypertension

Author Affiliations

Charlottesville, Va

Arch Intern Med. 1996;156(5):588. doi:10.1001/archinte.1996.00440050148020

The recent letter by Partanen and Nieminen1 reporting the death of a young woman suffering from primary pulmonary hypertension during inhaled nitric oxide therapy is misleading. They suggest that inhaled nitric oxide was responsible for the decreasing systemic blood pressure that occurred in the 9 hours immediately preceding death. We are told very little about this patient's history, clinical condition, or drug therapy at the time that inhaled nitric oxide therapy was initiated. However, we may assume that her disease was in the end stage, since "when last seen" she was dyspneic at rest and transplantation had been discussed, offered, and refused. The hemodynamic parameters tabled show a progressive decline in systemic blood pressure, systemic vascular resistance, and urinary output, but the cause of the circulatory failure was not determined. The authors suggest that the cardiovascular collapse was caused by the inhaled nitric oxide, but in view of published research

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