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Updated: Apr 23, 2026
A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Initial oxygenation response to inhaled nitric oxide predicts improved outcome in congenital diaphragmatic hernia
Sibel Tiryaki1, Coskun Ozcan, Ata Erdener
1Hacettepe University, Ankara, Turkey, tiryakisibel@gmail.com.
Insights
Inhaled nitric oxide therapy may improve survival for infants with pulmonary hypertension (PH) due to congenital diaphragmatic hernia (CDH). Early patient response to therapy is a key indicator of successful treatment outcomes.
Area of Science:
- Pediatric critical care medicine
- Neonatology
- Cardiopulmonary medicine
Background:
- Pulmonary hypertension (PH) is a significant complication of congenital diaphragmatic hernia (CDH), associated with high mortality rates.
- Effective management strategies for PH in CDH patients are crucial for improving outcomes.
Purpose of the Study:
- To assess the efficacy of inhaled nitric oxide (iNO) therapy in treating PH specifically in neonates with CDH.
- To identify potential predictors of treatment success for iNO therapy in this patient population.
Main Methods:
- A retrospective review of hospital records for pediatric patients treated with iNO for PH due to CDH between June 2009 and December 2011.
- Analysis of patient outcomes, including oxygenation levels (PaO2), in relation to iNO therapy initiation and response.
Main Results:
- Eight out of 29 CDH patients received iNO therapy due to failure of conventional ventilation; therapy was successful in five.
- Patients with a positive response to iNO showed rapid improvement in PaO2 (from 44.8 to 96.8 mmHg within one hour).
- Non-responders exhibited a less significant PaO2 increase (from 37 to 54.6 mmHg).
Conclusions:
- Inhaled nitric oxide therapy appears to enhance survival rates in infants suffering from PH secondary to CDH.
- While no specific patient selection parameters were identified, an early positive response to iNO therapy may predict overall treatment success.
- The study suggests that the combination of iNO with sildenafil and dopamine may contribute to favorable outcomes.
Background:
Pulmonary hypertension (PH) is the most important complication of congenital diaphragmatic hernia (CDH) and still has a high mortality rate. The aim of this study was to evaluate the effectiveness of inhaled nitric oxide therapy in PH due to CDH.
Methods:
Hospital records of children who had undergone inhaled nitric oxide therapy for PH due to CDH between June 2009 and December 2011 were reviewed.
Results:
Twenty-nine patients had a diagnosis of CDH at the time of study, and eight of these patients underwent nitric oxide therapy because of failure of conventional ventilation techniques, which was successful in five of these patients. Patients who had a good overall outcome of nitric oxide therapy experienced rapid improvement (pretreatment, mean PaO2 = 44.8 mmHg; after the first hour of therapy, mean PaO2 = 96.8 mmHg), whereas patients with no response did not have a similar course (pretreatment, PaO2 = 37 mmHg; after the first hour, PaO2 = 54.6 mmHg).
Conclusion:
Inhaled nitric oxide therapy seems to increase survival in PH due to CDH. No predictive parameters to orient patient selection could be identified; however, the early response seemed to predict the overall outcome. Good results in our series were attributed to routine use of sildenafil and dopamine, along with the nitric oxide inhalation.
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