Life-threatening status asthmaticus treated with inhaled nitric oxide

Inhaled nitric oxide (NO) was administered to 5 consecutive children with life-threatening status asthmaticus who required mechanical ventilation and did not respond to maximal medical management. Four showed a >20% decrease in baseline PaCO(2) (median PaCO(2) = 154 mm Hg, range = 95 to 229 mm Hg) occurring rapidly after the administration of inhaled NO. Three children, in addition to the index case, received continuous inhaled NO therapy, ranging from 5.5 to 21.5 hours. Systemic hypotension was not observed, and the maximum methemoglobin level was 1.9%. Four children survived to hospital discharge. Although the precise mechanism of action is not known, it appears that inhaled NO merits further study and may represent a life-saving therapy in this select patient population.