Inhaled nitric oxide in infants and children with ARDS

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Objective

To evaluate the effects of inhaled nitric oxide on gas exchange and outcome in pediatric patients with acute respiratory distress syndrome (ARDS).

Design

Case series report.

Setting

Pediatric intensive care unit of a tertiary care children's hospital.

Patients

Seventeen pediatric patients with ARDS requiring mechanical ventilation with an FiO₂ >0.5 at a positive end-expiratory pressure >6 cmH₂O, and whose PaO₂/FiO₂ratio was <100 torr were enrolled in this study.

Interventions

Initially inhaled (NO) was applied at 10 ppm using a microprocessor based system. A positive response after 15 min of NO inhalation was defined as an increase in arterial oxygen saturation >5%.

Measurements and main results

At the start of NO inhalation the oxygenation (OI=Paw^*FiO₂^*100/PaO₂) and ventilation (VI=PaCO₂^*PIP^*RR/1000) indices were 29± 2.8 and 43± 4.1, respectively, the PaO₂/FiO₂ ratio was 69± 7 torr, and the static compliance of the respiratory system 0.51± 0.04 ml/cmH₂O/kg. An initial positive response to inhaled NO was observed in 59% of patients.

Conclusion

Inhaled NO significantly improves oxygenation in 59% of infants and children with ARDS. However, an initial positive response to inhaled NO does not reduce the need for ECMO support and does not influence duration of mechanical ventilation and outcome of pediatric patients with severe ARDS.

Table 1 Change in oxygen saturation 15 min after starting NO inhalation, duration of MV, number of ECMO support, and outcome of pediatric patients with ARDS (n=17).