Changes in alveolar-arterial oxygen difference and oxygenation index during low-dose nitric oxide inhalation in 15 newborns with severe respiratory insufficiency.
We evaluated changes in alveolar-arterial oxygen differences (AaDO2) and oxygenation index (OI) during inhalation of low-dose nitric oxide (INO) in 15 newborns with severe respiratory insufficiency: congenital diaphragmatic hernia (CDH) -6, asphyxial lung disease -4, meconium aspiration syndrome (MAS) -2, respiratory distress syndrome -2, persistent pulmonary hypertension of newborn -1. Their mean birth weight was 2522 g (1030-3200 g, SD +/- 575), mean gestational age 36 weeks (29-39 weeks, SD +/- 3.2), mean initial AaDO2 = 607 mm Hg (574-628 mm Hg, SD +/- 14) and mean initial OI = 32 (6-57, SD +/- 12). INO was performed using the Pulmonox system (Messer Griesheim, Austria) at conventional regimens of mechanical ventilation. The initial value of 20 ppm nitric oxide (NO) was decreased 6 h later, first to 15 ppm and then, as quickly as possible, to 3 ppm. The mean inhalation period was 51 h (6-131 h, SD +/- 42). The initial value of AaDO2 and OI decreased significantly within the first 6 h of INO (P < 0.001). After the first 6 h, 4 patients died: 1 with MAS of an extrapulmonary cause and 3 CDH patients because of pulmonary hypoplasia. In the remaining 11 patients the decrease in AaDO2 and OI during the first 24 h of INO was highly significant (P < 0.0001).


CONCLUSIONS
In a heterogeneous group of 15 newborns with severe respiratory insufficiency, the initial AaDO2 and OI decreased significantly within the first 6 h of INO.
Department of Neonatal Intensive Care, Institute for the Care of Mother and Child, Prague, Czech Republic.
Z
Z
Stranák
V
V
Zábrodský
J
J
Simák
D001724:Birth Weight; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000628:therapy*; D009569:Nitric Oxide / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*
D009569:Nitric Oxide