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.