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Updated: Jun 4, 2026

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Inhaled nitric oxide improves systemic microcirculation in infants with hypoxemic respiratory failure
Anke P C Top1, Can Ince, Patrick H M Schouwenberg
1Erasmus Medical Center-Sophia Children's hospital, Rotterdam, the Netherlands. anke.top@addenbrookes.nhs.uk
Inhaled nitric oxide significantly improved systemic microcirculation in children with hypoxemic respiratory failure. This study demonstrates a potential benefit of inhaled nitric oxide for improving blood flow in critically ill children.
Area of Science:
- Critical Care Medicine
- Pediatric Pulmonology
- Neonatology
Background:
- Inhaled nitric oxide (iNO) is used to treat persistent pulmonary hypertension of the newborn and acute hypoxemic respiratory failure.
- iNO is thought to improve regional ventilation-perfusion matching via selective pulmonary vasodilation.
- Its effect on systemic microcirculation in pediatric patients is not well understood.
Purpose of the Study:
- To investigate the impact of inhaled nitric oxide on systemic microcirculation in children.
- To test the hypothesis that inhaled nitric oxide improves systemic microcirculation.
Main Methods:
- Pilot study conducted in a level III university children's hospital intensive care unit.
- Eight mechanically ventilated children (median age 0 months) with various respiratory conditions received inhaled nitric oxide (20 ppm).
- Systemic microcirculation was assessed using orthogonal polarization spectral imaging of the buccal mucosa before and after iNO initiation.
Main Results:
- Functional capillary density in the buccal mucosa significantly improved after initiating inhaled nitric oxide.
- Median functional capillary density increased from 4.0 cm/cm to 4.9 cm/cm (p = .017).
Conclusions:
- Inhaled nitric oxide administration leads to a significant improvement in systemic microcirculation in pediatric patients with hypoxemic respiratory failure.
- This finding suggests a broader beneficial effect of iNO beyond pulmonary vasculature.
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