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Excerpt
Introduction: NO improves pulmonary hypertension and hypoxia with ARDS. This study examines those patients who failed to show an initial response to NO and their behavior on subsequent exposure to NO. Methods: Study site: University Hospital, Level I Trauma Center over a two year period ending in 1997. Inclusion criteria: diffuse lung injury with a PaO2/FIO2≤200, on ≥10cm PEEP, mean pulmonary artery pressure (MPAP)30≥torr, and a wedge pressure ≤18 torr. Thirteen patients were treated with NO at 20 ppm; age 40±12 yrs; six male, seven female. Mean lung injury score 3.73±.34, APACHE II score 14.2±3.8. PaO2/FIO2 ratio 106±39 on PEEP 16±3cm H2O, MPAP 39±5 torr. Patients were classified as responders if the PaO2/FIO2 improved by 15% or MPAP decreased by 10%. Non-responders were restudied in 24 hours. Data were analyzed using ANOVA, Fisher's exact test and linear regression analysis. RESULTS: The initial exposure to NO resulted in a statistically significant improvement. However, the changes were small. Only one patient responded in both parameters. Of the twelve patients eligible for reexposure to NO, two patients died prior to retreatment and two had sufficient responses that it was judged unsafe to discontinue NO. During secondary treatment the eight patients demonstrated significantly greater improvement. (See Table) Conclusion: Patients showing minimal or no response to inhaled NO at initial exposure should be retreated at 24 - 48 hours.
