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Nitric oxide inhalation and high frequency oscillatory ventilation for hypoxemic respiratory failure in infants
1Department of Neonatology, Wolfson Medical Center, Holon, Israel. kdavid@post.tau.ac.il
Background:
High frequency oscillatory ventilation has proved valuable in recruiting and sustaining lung volume; the combined treatment may augment nitric oxide delivery to target vessels. NO therapy lowers pulmonary resistance and improves oxygenation.
Objective:
To retrospectively review data on changes in oxygenation-indicated by arterial/alveolar PO2 ratio, oxygenation index, and outcome--in a cohort of 10 infants with hypoxemic respiratory failure in whom nitric oxide inhalation was instituted in a compassionate-use protocol after deteriorated oxygenation.
Methods:
NO inhalation was administered at a range of 0.12-122 days of life using the SensorMedics system in 10 infants who developed hypoxemic respiratory failure associated with a variety of lung diseases while on HFOV.
Results:
The infants' birthweight was 1,717 +/- 1,167 g and their gestational age 31.1 +/- 6.5 weeks. Mean exposure to NO inhalation was 14.2 days and ranged from 3-59 days. Oxygenation index decreased from 39.3 +/- 13.2 to 12.7 +/- 6.9 (P < 0.0002) after NO therapy. Despite an initial prompt response to NO inhalation, two patients died of progressive intractable respiratory failure and one term infant died of extrapulmonary complications (hypoxic ischemic encephalopathy grade III and multiorgan failure).
Conclusion:
Our results indicate that the combined treatment of HFOV and NO inhalation is superior to HFOV alone for improving oxygenation in a selected cohort of infants ventilated for a variety of lung diseases.