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[Nitric oxide treatment in children: clinical course, toxicity and factors influencing its effects]
J López-Herce Cid1, A Sánchez Galindo, A Carrillo Alvarez
1Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañóa, Madrid.
Insights
Inhaled nitric oxide (NO) improved oxygenation and pulmonary hypertension in children without side effects. Factors influencing NO treatment response in pediatric patients were not identified.
Area of Science:
- Pediatric critical care medicine
- Pulmonary medicine
- Pharmacology
Background:
- Inhaled nitric oxide (NO) is used to treat hypoxemia and pulmonary hypertension in children.
- Its long-term efficacy and factors influencing response require further investigation.
Purpose of the Study:
- To analyze the clinical evolution, acute toxicity, and predictive factors of inhaled NO treatment response in pediatric patients.
- To assess the impact of NO on oxygenation and pulmonary hypertension in children with refractory conditions.
Main Methods:
- Prospective study of 25 children (15 days to 16 years) with Acute Respiratory Distress Syndrome (ARDS) or Pulmonary Hypertension (PHT).
- Treatment involved inhaled NO (1.5-45 ppm) for 45 minutes to 47 days.
- Evaluated secondary effects, morbidity, mortality, and correlations with age, sex, diagnosis, and physiological parameters.
Main Results:
- Inhaled NO improved oxygenation and pulmonary hypertension without tachyphylaxis or significant secondary effects (NO2 < 2 ppm, methemoglobinemia < 3.5%).
- No correlation was found between NO's effect and patient factors like age, sex, or diagnosis.
- Survival rate was 48% (12/25), with higher survival in ARDS patients (53%) compared to PHT patients (38%).
Conclusions:
- Prolonged inhaled NO administration effectively improves oxygenation and pulmonary hypertension in children with minimal acute toxicity.
- No predictive factors for clinical response to inhaled NO were identified in this pediatric cohort.
Objective:
The purpose of this study was to analyze the clinical evolution, acute toxicity and factors which influence the response to nitric oxide treatment in children.
Patients And Methods:
We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT. All patients presented hypoxemia and/or PHT refractory to conventional therapy and were treated with inhaled NO (1.5 to 45 ppm) between 45 minutes to 47 days. We studied the secondary effects, morbidity and mortality, and analyzed the relationship between NO effects and age, sex, diagnosis, infection, previous PaO2/FiO2 ratio, previous oxygenation index and previous mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP).
Results:
The effect of NO was maintained during the time of administration without tachyphylaxis. There were no secondary effects of NO administration. NO2 was always < 2 ppm and metahemoglobinemia was below 3.5%. There was no relationship between the effect of NO and the rest of the factors analyzed. Twelve patients (48%) survived, 9 of the children with ARDS (53%) and 3 of the children with PHT (38%). Eleven of the 21 patients who improved with NO treatment survived (52%), as did 1 of the 4 patients who did not improve (25%).
Conclusions:
Prolonged administration of inhaled NO at low concentrations maintains the improvement of oxygenation and pulmonary hypertension without acute secondary effects. We have not found factors that could predict the clinical response to NO.