Chest
Volume 114, Issue 3, September 1998, Pages 827-833
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Efficacy of Inhaled Nitric Oxide in Children With ARDS

https://doi.org/10.1378/chest.114.3.827Get rights and content

Study objective: Data concerning inhaled nitric oxide (iNO) on pediatric ARDS is rare. We investigated the effects of iNO on pediatric ARDS in order to examine the ability to predict a response to iNO, the optimal concentration of iNO, the effects of ≤1 ppm nitric oxide (NO), and the effect of iNO on PaCO2.

Setting: ICU at Kumamoto (Japan) University Hospital.

Patients and interventions: Seven children with ARDS. The initial responses to 16 ppm NO and the dose-response effects of 0.13 to 16 ppm NO were assessed.

Measurements and results: Sixteen ppm of iNO improved oxygenation in all seven children. The use of iNO significantly increased the ratio of arterial oxygen tension to the fraction of inspired oxygen (PaO2/FIo2). A correlation between the NO-induced increase in PaO2/FIo2 and the baseline PaO2/FIo2 was observed (r=0.93, p<0.01). Dose-response tests showed that the optimal concentration of iNO was ≤4 ppm, improvements in PaO2/FIo2 could be observed with concentrations of ≤1 ppm NO, and iNO induced a slight decrease in PaCO2.

Conclusions: In children with ARDS, iNO frequently improves oxygenation and induces a slight decrease in PaCO2, with the baseline PaO2/FIo2 functioning as a predictor of all NO response. Improvements of PaO2 and PaCO2 were observed with concentrations of iNO of ≤1 ppm, a level in which the risk of a toxic reaction in children is minimal. Effects on outcome need verification in larger controlled trials.

(CHEST 1998; 114:827–833)

Abbreviations: DAP=diastolic arterial pressure; FIo2=fraction of inspired oxygen; HR=heart rate; iNO=inhaled nitric oxide; MAP=mean arterial pressure; NO=nitric oxide; NO2=nitric dioxide; P(A-a)O2=alveolar-arterial oxygen pressure difference; PaO2/FIo2=ratio of arterial oxygen tension to the fraction of inspired oxygen; PeRF=pediatric respiratory failure; SAP=systolic arterial pressure; SpO2=arterial oxygen saturation measured by pulse oximetry

Section snippets

MATERIALS AND METHODS

This study was approved by the institutional review board at the Kumamoto University Hospital. Patients were enrolled after informed consent was obtained from their parents.

RESULTS

Seven children with severe ARDS, ranging from 2 months to 17 years of age, were studied (Table 1), including three boys and four girls. The ARDS score was ≥3.0 in each case. Three children had ARDS due to sepsis during therapies for tyrosinemia, acute leukemia, and acute hepatitis. Three had ARDS due to viral pneumonia and one due to a near-drowning. Duration between the time of the diagnosis of ARDS and initiation of NO inhalation ranged from 2 h to 5 days. The mean mortality risk estimated by

DISCUSSION

The major findings of the present study were that (1) children with severe ARDS had variable responses to iNO, (2) the magnitude of improvement in oxygenation correlated with the baseline PaO2/FIO2 ratio, and (3) improvements in arterial oxygenation could be observed with concentrations of iNO of ≤1 ppm.

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    Manuscript received July 9, 1997; revision accepted February 26, 1998.

    Supported by Grant-in Aid for Scientific Research No. 07457360, 09470333, and 09771172, Ministry of Education, Science and Culture, Japan.

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