Low-dose inhaled nitric oxide improves the oxygenation and ventilation of infants and children with acute, hypoxemic respiratory failure

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Abstract

Objective

To describe the effects of inhaled nitric oxide on oxygenation and ventilation in patients with acute, hypoxic respiratory failure and to characterize those who respond to low doses with a significant improvement in PaO2.

Design

Prospective dose response trial of inhaled nitric oxide. Patients who demonstrated a >or=to15% improvement in PaO2 were randomized to receive conventional mechanical ventilation with or without prolonged inhaled nitric oxide.

Setting

Pediatric intensive care unit of a tertiary care children's hospital serving as a regional referral center for respiratory failure.

Patients

Pediatric patients with an acute parenchymal lung disease requiring mechanical ventilation, an FIO2 of >or=to0.5, a positive end-expiratory pressure of >or=to7 cm H2 O, and whose PaO2/FIO2 ratio was Interventions

PaO2, PaCO2, pH, heart rate, blood pressure, and methemoglobin were recorded at baseline and after inhaling 1, 5, 10, and 20 ppm of nitric oxide. Peak expiratory flow rate and mean airway resistance were measured while subjects received 0 and 20 ppm of inhaled nitric oxide. Patients were followed up until extubation or death.

Measurements and Main Results

Twenty-six patients (median age, 2.6 yrs [range, 1 mo-18.2 yrs]) were enrolled in the study. PaO2 increased (p < .001) and PaCO (2) fell (p < .0001) from baseline with the administration of inhaled nitric oxide. There was no statistical difference among 1, 5, 10, and 20 ppm with regard to effects on oxygenation. Sixteen patients (62%) responded to inhaled nitric oxide with a >or=to15% improvement in PaO2; 14 of these responses occurred at a dose of 1 or 5 ppm. Response to inhaled nitric oxide was not associated with age, length of intubation, presence of primary lung disease, chest radiograph, or illness severity. Among patients weighing Conclusions

Inhaled nitric oxide at doses of

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