CASE REPORT article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1627953
This article is part of the Research TopicInnovative Monitoring and Management of Perioperative Complications in Cardiac SurgeryView all 8 articles
The Role of Nitric Oxide Inhalation and Prone Positioning Ventilation in Oxygen Improvement in Patients with Refractory Hypoxemia Following Acute Type A Aortic Dissection Surgery：Two Cases Report and Literature Review
Provisionally accepted
- 1Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- 2Dongyang People' Hospital of Wenzhou Medical University, Dongyang, China
- 3The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Refractory hypoxemia following Acute Type A Aortic Dissection (ATAAD) surgery presents a significant clinical challenge. How to improve the refractory hypoxemia after ATAAD surgery is very critical for achiving perfect outcome of these patients. We report two cases of severe hypoxemia after ATAAD surgery that improved with inhaled nitric oxide(iNO) and prone positioning ventilation(PPV) therapy, despite traditional treatments including ventilator parameter optimization, performance of recruitment maneuvers, administration of glucocorticoids, diuresis and/or CRRT used for maintenance of a negative fluid balance, and secretion aspiration via fiberoptic bronchoscopy. Finally, these two patients were successful weaned from mechanical ventilation and subsequent discharge from the hospital.We provide the successful experience in the application of combination treatment of iNO and PPV in patients with refractory hypoxemia after ATAAD surgery, which will pave the way for the following randomized controlled clinical trials.Keywor ds: nitric oxide, prone positioning, aortic dissection, hypoxemia,case report words：2446. Figures:2. Table :1 Acute Type A Aortic Dissection (ATAAD) represents a critical cardiovascular disorder, characterized by the involvement of ascending aorta and the need of emergency surgical intervention as the principal therapeutic approach.Among the postoperative complications associated with ATAAD, refractory hypoxemia is particularly notable for its adverse impact on patient outcomes. Therefore, hHerein, we present two cases of severe hypoxemia following ATAAD surgery ever after traditional therapeutic strategies and prone position ventilation, who obtained enhanced oxygenation after the introduction of inhaled nitric oxide therapy.
Keywords: Nitric Oxide, prone positioning, aortic dissection, hypoxemia, case report
Received: 13 May 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Wang, Sun, Yang, Shao, Kong, Cui, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lixue Wang, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Gensheng Zhang, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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