The pulmonary circulation operates within a low-pressure circuit at a mean pressure of less than 20 mmHg, as opposed to the systemic circulation. Thus, pulmonary hypertension occurs when the pressure within the pulmonary circulation circuit rises, and the condition is associated with hypoxia as a significant consequence. Hypoxia is a condition where there is a low supply of oxygen to the body tissues. In Australia, the disease presents a serious health concern because death occurs in the majority of patients diagnosed with the condition. Inhaled Nitrogen Oxide (iNO) is a standard approach that is utilized in caring for patients with pulmonary hypertension, especially those who have undergone surgery that may induce high pressure in the blood system (Prior et al., 2016). Pulmonary hypertension is caused by numerous factors that are classified based on the initiating factor and whether the central region of the pulmonary circulation affected is pre- or postcapillary.
Patients with pulmonary hypertension (PH) generally have elevated levels of oxidative stress that significantly contributes to the ultimate fibrosis that is common in the hearts and lungs of patients diagnosed with the condition. Oxidative stress has been highlighted as a common problem among patients undergoing surgery for heart transplant or insertion of a left ventricular assist device (Prior et al., 2016). Thus, traditional iNO administration has been effectively used in Australia to lower pulmonary pressure, which consequently reduces the mitochondrial metabolic rate within the ventricles and decreased oxidative stress (Petit et al., 2017). When the patient inhales nitric oxide, it diffuses into the smooth muscle to cause vasodilation. When taken into the lungs for treating PH, the inhaled gas lowers pulmonary arterial pressure and pulmonary vascular resistance in patients who show problems of vasoreactivity. Inhaled NO minimizes and prevents PH for patients, particularly those undergoing surgery and those who are highly predisposed to a dysfunction of the right ventricle. Physicians have extensively utilized NO for patients with congenital heart disease, respiratory distress syndrome, and valvular heart disease (Petit et al., 2017).
Inhaled nitric oxide has a vasodilatory effect that is typically effective in properly dilated areas of the lungs to treat hypoxia. In such regions of the lungs, the gas selectively dilates blood vessels, thus leading to an improvement in the matching of ventilation and perfusion actions. The localized impacts of NO are visible in concentrated areas where there is an excellent potential of addressing the problem within the shortest time possible and limit the advancement of associated disorders (Petit et al., 2017). Again, inhaled nitric oxide has been effective in treating respiratory distress because it is easier to administer to patients and has a range of positive, evidence-based clinical outcomes. Patients recovering from surgery form the most common group of patients whose condition is addressed using iNO (Petit et al., 2017). Hypoxia limits the body’s access to oxygen within the tissues, and the impacts are detrimental because rising carbon dioxide levels lead to toxic concentrations that can affect not only the lungs but also other major body systems that require oxygen nourishment for efficiency. Heart failure is associated with pulmonary hypertension, and the condition threatens the normal functioning of a patient’s liver, kidneys, and gut (Prior et al., 2016). Adults or children are affected in equal measure, although the condition is manifested differently with severity differing based on the advancement of the disease.
Pulmonary hypertension is a critical health issue today as a primary cause of sclerosis-associated deaths as the high mortality rates of patients affected by the condition. Hypoxia is a common condition associated with PH where oxygen supply to the tissues is limited, and inhaled nitric oxide has been extensively used in Australia to treat the disease through the mechanism of localized pulmonary vasodilation (Petit et al., 2016). The condition of pulmonary hypertension hinders the proper exchange of oxygen and carbon dioxide in the lungs and is associated with low nitric oxide concentration in the body. When a patient experiences heart failure on the right side of the heart, the consequence could be a right-side systolic or diastolic heart failure. Hypoxia, as the collective effect of pulmonary hypertension, often occurs in affiliation with systolic pulmonary hypertension. Dealing with the problem of hypoxia also targets a reduction of any lung inflammations and restoring the optimal exchange of carbon dioxide and oxygen gases so that oxygen can reach the body tissues (Petit et al., 2017). The condition of pulmonary hypertension is rare in Australia, but its impacts are severe as they affect clinical outcomes because of poor prognosis if not treated in time. Pharmacological treatment options have improved over the past years, with most of them targeting hypoxia and concentrating within the nitric oxide, endothelin, and prostacyclin pathways for effectiveness. Using the right treatment or prevention option has shown successful outcomes in disease progression, lower mortality, and minimization of patient symptoms (Prior et al., 2016). The primary step to addressing the condition is identifying the risk factors that may increase patient susceptibility to the disease and early screening to identify and implement the correct approach to minimizing the impact of hypoxia. Chronic thromboembolic pulmonary hypertension is the primary cause of pulmonary hypertension, and caregivers should assess the symptoms and implement the appropriate care therapy. Other than combinations of PAH drugs, physicians in Australia recommend the use of inhaled nitric oxide to combat the signs of the condition through the vasodilation mechanism to reduce oxidative stress.
The pulmonary circulation functions under low pressure and any noticeable increase in the pressure, supposedly to 25 mmHg at rest, from the average 20 mmHg indicate the presence of pulmonary hypertension (Prior et al., 2016). Pulmonary hypertension is associated with an unreliable prognosis, which is typically associated with heart failure on the right side of the organ when there is continuously elevated afterload. Based on the causes, there are several divisions to pulmonary hypertension, and the first type is pulmonary arterial hypertension (PAH), which is caused by vascular proliferation and intensive obstruction, which majorly affects the arterial region of the system. PAH is associated with a normal left atrial pressure and a high pulmonary vascular resistance with the conventional forms being idiopathic PAH, familial PAH, and pulmonary arterial hypertension that is linked to systemic sclerosis (Prior et al., 2016). Idiopathic PAH has minimal prognosis if the condition is not addressed in time, while chronic thromboembolic pulmonary hypertension is the aftermath of poor strategies applied in treating pulmonary embolism. Consequently, iNO has been used extensively in Australia as a primary, selective pulmonary vasodilator, which elevates the ventilation-perfusion mismatch and improves oxygenation in patients, thus lowering hypoxia that causes respiratory distress.
Petit, P.C., Fine, D.H., Vásquez, G.B., Gamero, L., Slaughter, M.S., and Dasse, K.A., 2017. The pathophysiology of nitrogen dioxide during inhaled nitric oxide therapy. Asaio Journal, 63(1), pp.7-13. Retrieved from https://journals.lww.com/asaiojournal/Fulltext/2017/01000/The_Pathophysiology_of_Nitrogen_Dioxide_During.3.aspx
Prior, D.L., Adams, H. and Williams, T.J., 2016. Update on pharmacotherapy for pulmonary hypertension. Medical Journal of Australia, 205(6), pp.271-276. Retrieved from https://www.mja.com.au/system/files/issues/205_06/10.5694mja16.00468.pdf