Inhaled nitric oxide for a severe respiratory syncytial virus infection in an infant with bronchopulmonary dysplasia.
OBJECTIVE
To report the first case of ARDS in children treated with nitric oxide (NO) inhalation.


METHODS
A 13-months infant presented with BPD and severe hypoxemia related to RSV infection and ARDS. Inhaled NO was delivered in the ventilatory circuit of a continuous flow ventilator (Babylog 8000, Dräger) in a concentration of 20-80 ppm for 7 days. NO and NO2 were continuously monitored (Polyton Draeger). Respiratory mechanics were evaluated by using the method of passive inflation by the ventilator.


RESULTS
NO inhalation improved oxygenation (tcSaO2) and reduced respiratory system resistance without affecting arterial pressure. NO2 level remained below 5 ppm, and methaemoglobin level below 1%. The child survived without neurologic sequela.


CONCLUSIONS
Two mechanisms to explain oxygenation improvement can be suggested: selective improvement in perfusion of ventilated regions and bronchodilation.
Leclerc
F
F
Service de Réanimation Infantile, Hôpital Calmette, Lille, France.
Riou
Y
Y
Martinot
A
A
Storme
L
L
Hue
V
V
Flurin
V
V
Deschildre
A
A
Sadik
A
A
D001784:Blood Gas Analysis; D001794:Blood Pressure; D001997:Bronchopulmonary Dysplasia / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000628:therapy*; D012138:Respiratory Therapy; D014692:Ventilation-Perfusion Ratio
D009569:Nitric Oxide