PEDIATRICS Vol. 92 No. 3 September 1993, pp. 403-408
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Endotracheal Administration of Tolazoline in Hypoxia-Induced Pulmonary Hypertension

Jerri Curtis MC, USNR1, J. Timothy O'Neill PhD2, and Gary Pettett MC, USA1

1 From the Department of Pediatrics, Section on Neonatal Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD and the Departments of Pediatrics and Clinical Investigation, Walter Reed Army Medical Center, Washington, DC
2 From the Department of Pediatrics, Section on Neonatal Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Study objective. To compare the pulmonary and systemic vascular responses to intravenously (IV) and endotracheally (ET) administered tolazoline (Tz) in newborn lambs with hypoxia-induced pulmonary hypertension.

Design. Randomized, controlled study design.

Methods. Twenty lambs, 2 to 7 days of age, were anesthetized, intubated, and surgically catheterized for continuous physiologic monitoring and cardiac output meassurements using radiolabeled microspheres. After a postoperative stabilization period, the lambs were ventilated with a hypoxic gas mixture which was titrated to increase mean pulmonary artery pressure (MPAP) 30% to 50% above baseline. Each animal was randomly assigned to receive either IV-Tz (2 mg/kg), ET-Tz (4 mg/kg), or ET-saline (Sal, control group).

Results. ET-Tz significantly (P < .05) reduced MPAP, PVRI (pulmonary vascular resistance index), MPAP/mean artery pressure (MAP) and PVRI/systemic vascular resistance index (SVRI), but not SVRI. IV-Tz lowered (P < .05) MPAP, PVRI, and PVRI/SVRI but also produced significant reductions in MAP and SVRI while only transiently decreasing MPAP/MAP. MPAP/MAP and PVRI/SVRI ratios were consistently lower in the ET-Tz animals than either the IV-Tz or ET-Sal animals.

Conclusions. Our results suggest that ET-Tz produced a more selective pulmonary vascular response than IV-Tz and may warrant further investigation for potential clinical applications.

Key Words: tolazoline • mean pulmonary artery pressure • persistent pulmonary hypertension of the newborn • hypoxia • pulmonary vascular resistance • systemic vascular resistance

Submitted on December 11, 1992
Accepted on March 9, 1993




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