INHALED NITRIC OXIDE THERAPY IN PEDIATRIC
ACUTE RESPIRATOPY DISTRESS SYNDROME
Pavlinova V.V.
Regional Children’s Hospital, Stavropol, Russia
OBJECTIVE: The aim of this study was to evaluate
the effect of nitric oxide inhalation in pediatric acute respiratory
distress syndrome patients with respect to dosage, prolonged inhalation,
and weaning.
MATERIALS AND METHODS: In this prospective
study, we evaluated 25 children, aged between 15 d and 17 years with acute
respiratory distress syndrome who underwent inhaled nitric oxide between
1997 and 2000. The patients inhaled doses between 1 and 100 parts per
million of nitric oxide. The oxygenation index was>20 cm H2O/torr.
Hemodynamic and blood gas measurements were performed at baseline, at 1
hour after the patients had stabilized, and at 24-h intervals for all
period of inhalation.
RESULTS: Results show that was to secondary effects of
nitric oxide inhalation administration. At the same time within 24 hrs of
nitric oxide inhalation mean oxygenation index decreased by 53%, mean
systemic arterial pressure increased by 13% and alveolar-arterial O2
gradient decreased by 28%. Dose-response tests showed that the optimal
concentration of nitric oxide inhalation was 10 parts per million. In our
experience prolonged oxide inhalation (to 10 days) in pediatric acute
respiratory distress syndrome patients showed improvement of oxygenation
without acute secondary effects. An oxygenation index of<5cm H2O/torr
predicted successful withdrawal, with a sensitivity of 72% and a
specificity of 84%.
CONCLUSIONS: Inhaled nitric oxide therapy improves
gas exchange and lowers pulmonary vascular resistance with concomitant
hemodynamic stabilization in children with acute respiratory distress
syndrome. Therapy is not associated with significant clinical toxicity or
adverse effects.