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Nitric oxide application during superimposed high-frequency jet-ventilation in patients with ARDS


Inhaled nitric oxide (NO) reduces pulmonary hypertension in severe ARDS and improves arterial oxygenation by redistributing blood flow to areas with a normal ventilation/perfusion ratio [1]. As high peak inspiratory pressure (PIP) may contribute to pulmonary damage ventilatory strategies like high-frequency (HF) ventilation search to minimize PIP. This study was designed to evaluate the combined benefits of superimposed high-frequency jet-ventilation (SHFJV), a new HF jet-ventilation technique, with addition of inhalational NO.


10 patients with severe ARDS were evaluated. All patients where ventilated with a conventional respirator (Evita, Dräger, Germany). The indication for SHFJV was a Horrowitz Index below 100. An electronic prototype jet-ventilator (Alexander 1, Reiner, Austria) used for SHFJV provided simultaneous low-(14-20/min) and high-frequency (400-600/min) jet-streams, which were applied with a special jet-adapter. For application of NO we used the Pulmonox mini (Messer Griesheim, Austria) including a specially developed computer software for precise addition of NO (10 ppm) to the HF jet-stream during inspiration [2]. After 3 h of jet-ventilation we additionally applied NO.


PaO2/FiO2 and Horowitz index increased during SHFJV and NO application, while PIP could be reduced maintaining the same levels of CO2 (Table 1).


The beneficial effect of SHFJV on oxygenation can be combined with the selective effects of inhaled NO. Thereby, impaired pulmonary function can be further improved.

Table 1


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  2. SchragI E: . Anaesthetist. 1995, 44: 843-10.1007/s001010050220.

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Kepka, A., Schabernig, C., Ihra, G. et al. Nitric oxide application during superimposed high-frequency jet-ventilation in patients with ARDS. Crit Care 2 (Suppl 1), P113 (1998).

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