Which of the following drugs would be the best choice to treat a child with elevated pulmonary vascular resistance who also has low blood pressure associated with low systemic vascular resistance:
a) Dobutamine
b) Epinephrine
c) Inhaled Nitric Oxide
d) Milrinone
Answer c. Of the available choices, inhaled nitric oxide (iNO), dobutamine, and milrinone will all achieve the desired effect of pulmonary vasodilation, but milrinone and dobutamine are far more likely to cause vasodilation and worsen hypotension. The systemic side effects of iNO are minimal due to its short halflife. Epinephrine would improve blood pressure but is also likely to worsen pulmonary hypertension.