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Inhaled nitric oxide in infants and children
1Le Bonheur Children's Medical Center, Memphis, Tennessee 38103, USA. warel@lebonheur.org
Abstract:
NO has been used successfully to treat PPHN, reducing the need for ECMO. NO has also been used in the cardiac catheterization laboratory to determine if pulmonary hypertension will decrease with NO. Patients who do not respond to NO are at higher risk after open-heart surgery, because their pulmonary hypertension will be difficult to treat. Postoperatively, NO can be used to determine if pulmonary hypertension is caused by vasoconstriction or by an obstruction. Inhaled Nitric Oxide at a Glance:
Action:
Selective pulmonary vasodilation without systemic vasodilation. USE: Treatment of pulmonary hypertension.
Concentration And Route:
Lowest concentration that will produce pulmonary vasodilation and improved oxygenation. Concentration should be kept < 80 ppm.
Contraindication:
Neonate that is ductal-dependent.
Toxic Effects:
Keep methemoglobin level < 5%. Keep nitric dioxide, which can cause lung damage, < 7 ppm. Risk of bleeding.
Monitor:
Levels of NO/NO2. Platelets. Arterial blood gas (ABG). Methemoglobin.
Weaning:
Decrease NO by 20%, monitoring ABG at 3- to 4-hour intervals. If there is a decrease in oxygenation, increase NO. Increase FIO2 20% when NO is discontinued. Unsuccessful treatment with NO--keep on NO until ECMO is available.