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[Acute effects of inhaled nitric oxide in children]
J López-Herce Cid1, E Cueto Calvo, A Carrillo Alvarez
1Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marafión, Madrid.
Insights
Inhaled nitric oxide (NO) therapy improved oxygenation and reduced pulmonary hypertension in children with acute respiratory distress syndrome (ARDS) and pulmonary hypertension (PHT). This treatment offers a significant therapeutic option for pediatric patients with these critical respiratory conditions.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Pharmacology
Background:
- Acute Respiratory Distress Syndrome (ARDS) and Pulmonary Hypertension (PHT) are severe conditions in children.
- Conventional therapies often prove insufficient for refractory hypoxemia and PHT in pediatric patients.
- Inhaled nitric oxide (NO) is a targeted vasodilator with potential benefits in pediatric respiratory failure.
Purpose of the Study:
- To evaluate the efficacy of inhaled nitric oxide (NO) as a therapeutic intervention.
- To assess the impact of inhaled NO on oxygenation and pulmonary arterial pressure in pediatric patients with ARDS and/or PHT.
- To determine response rates to inhaled NO in a cohort of critically ill children.
Main Methods:
- Prospective study of 25 children (15 days to 16 years) with ARDS and/or PHT refractory to standard treatment.
- Administration of inhaled NO at varying concentrations (1.5-45 ppm) for durations ranging from 45 minutes to 47 days.
- Monitoring of key respiratory and hemodynamic parameters, including PaO2/FiO2 ratio, oxygenation index, and mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP) ratio before and after treatment.
Main Results:
- Inhaled NO significantly improved oxygenation, with 84% of patients showing a >15% increase in the PaO2/FiO2 ratio.
- Mean PaO2 increased from 87.4 to 133.6 mmHg and PaO2/FiO2 ratio from 95.4 to 157.5.
- Pulmonary hypertension was reduced, with 66% of patients experiencing a >15% decrease in the PAP/SAP ratio, from 59.9% to 42.6%.
Conclusions:
- Inhaled nitric oxide (NO) demonstrates significant efficacy in improving oxygenation in pediatric patients with ARDS and/or PHT.
- Inhaled NO effectively reduces elevated pulmonary arterial pressures in this vulnerable pediatric population.
- Inhaled NO represents a valuable therapeutic option for children suffering from severe respiratory compromise due to ARDS and/or PHT.
Objective:
The objective of this study was to analyze the therapeutic response to inhaled nitric oxide (NO) in children with acute respiratory distress syndrome (ARDS) and/or pulmonary hypertension (PHT).
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, four of which had secondary ARDS. All patients presented hypoxemia and/or PHT refractory to conventional therapy. We analyzed the PaO2/FiO2 ratio, oxygenation index and mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP) before and after treatment with inhaled nitric oxide. Patients were treated with inhaled NO at 1.5 to 45 ppm between 45 minutes to 47 days.
Results:
NO improved oxygenation, increasing by greater than 15% the PaO2/FiO2 ratio in 84% of the patients. In those patients which improved, PaO2 increased from 87.4 +/- 57.7 mmHg to 133.6 +/- 60.1 mmHg (p < 0.001), the PaO2/FiO2 ratio from 95.4 +/- 60.9 to 157.5 +/- 86.8 (p < 0.0001) and the oxygenation index diminished from 25.6 +/- 15.6 to 17 +/- 12.4. The PAP/SAP ratio diminished by greater than 15% in 66% of the patients, decreasing from 59.9 +/- 24.5% to 42.6 +/- 14.1% (p = 0.01).
Conclusions:
Inhaled NO improved oxygenation and decreased pulmonary hypertension in an important number of children with ARDS and/or PHT.