THE EFFECTS OF INHALED NITRIC OXIDE IN THE TREATMENT OF
6 CHILDREN WITH SEVERE RESPIRATORY FAILURE
Zhu-jin Lu, Lin-en Zhang, Bo Sun
Department of
Pediatrics, Children’s Hospital, Shanghai Medical University Shanghai,
China
Objective: Although
there is much achievement in the treatment of respiratory failure,
difficulties still exist in patients with ARDS or other severe respiratory
failure. We recently applied inhaled nitric oxide (iNO) for treatment of 6
children with severe hypoxic respiratory failure.
Methods: 6
children, aged from 2-month to 11-year with severe hypoxic respiratory
failure due to pneumonia and pulmonary edema. All children had poor
response to conventional mechanical ventilation within the first 24 hours
(SpO2 75 ~ 85% when FiO2>0.6, PaO2/FiO2 = 87±29). iNO (5 ~ 20ppm) was given continuously to each patient through
the tubes of the ventilator, and the duration of iNO treatment was 3 ~ 5
days. One of them was treated with combination of high frequency
oscillation.
Results: (1) All
children responded to iNO, and pulse oxygen saturation improved (SpO2 from 80.16±7.57 % to 90.5 %±3.14; PaO2/FiO2 from 87±29 to 120.6±55). (2) 4/6 Chest X-ray after iNO 24 hours indicated
that pulmonary edema become absorbed. (3) Respiratory compliance (Crs)
improved (from 0.66±0.48 to 0.69±0.50 ml/kg/ cmH2O).
(4) The iNO side effects were not found in all cases. The methemoglobin
level during iNO was 0.6 ~ 1.6 %.
Conclusion: iNO
could significantly improve pulmonary oxygenation in children with severe hypoxic
respiratory failure by dilatation of pulmonary vessels and correction of
the V/Q mismatch, and had found no side effects associated with iNO in the
treatment concentration. iNO is one of the effective methods in the
treatment of pediatric severe hypoxic respiratory failure.