Inhaled nitric oxide for avoidance of extracorporeal membrane oxygenation in the treatment of severe persistent pulmonary hypertension of the newborn.
Inhaled nitric oxide (NO) is thought to provide a noninvasive therapeutic alternative to extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).


OBJECTIVE
Since January 1993, we have studied inhalation of NO in PPHN patients meeting the ECMO criteria of our institution. We focused on the questions of whether or not the need for ECMO could be obviated and whether differences could be found between NO responders and nonresponders.


METHODS
NO gas was delivered via conventional IPPV ventilation in incrementally increasing concentrations from 20 to 80 ppm.


METHODS
NO therapy was attempted in ten ECMO candidates with clinical and echocardiographical evidence of PPHN (mean OI 51.9, SD 10.4).


RESULTS
At various NO levels (30-60 ppm), five patients showed a significant increase in mean PaO2 (range 32.9-85.9 mmHg). Improvement was transient in three patients (6-10 h) and prolonged in two others (54-80 h); in the latter cases, ECMO was avoided. Five patients did not respond at all to treatment. Responders and nonresponders differed in their mean respiratory tidal volume (8.9 vs 4.18 ml/kg, P <0.05).


CONCLUSIONS
In our study, inhalation of NO obviated the necessity of ECMO therapy in only two out of ten PPHN patients. Thus, we would discourage any overoptimistic expectations about the effectiveness of NO therapy in PPHN until larger clinical trials have been performed.
Muller
W
W
Kinderklinik, Neonatal ICU, Theodor-Kutzer-Ufer, Mannheim, Germany.
Kachel
W
W
Lasch
P
P
Varnholt
V
V
Konig
S A
SA
D000280:Administration, Inhalation; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000494:pharmacology / Q000627:therapeutic use*; D010547:Persistent Fetal Circulation Syndrome / Q000628:therapy*; D015656:Respiratory Mechanics / Q000502:physiology
D009569:Nitric Oxide