Inhaled Nitric Oxide RV Failure — FRCA Final MCQ

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HardIntensive Care MedicineInhaled Nitric Oxide RV FailureFRCA Final

A 72-year-old man (ASA IV) with severe pulmonary hypertension (mean PAP 60 mmHg) develops right ventricular failure in the ICU. Which inhaled pulmonary vasodilator is used as a rescue therapy?

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Correct answer: B — Inhaled nitric oxide at 20-40 ppm

Inhaled nitric oxide (iNO) at 20-40 ppm is a selective pulmonary vasodilator used as rescue therapy in acute right ventricular failure with pulmonary hypertension. It is delivered directly to ventilated alveoli, causing vasodilation of adjacent pulmonary vessels. This selectively reduces PVR without causing systemic hypotension (because NO is rapidly inactivated by haemoglobin in the pulmonary capillaries before reaching the systemic circulation). Inhaled prostacyclin (epoprostenol/iloprost) is an alternative. Weaning must be gradual to avoid rebound pulmonary hypertension. Monitoring for methaemoglobinaemia is required.

Reference: ESC – 2022 – Pulmonary hypertension guidelines; ICS – 2023 – RV failure management