Electroencephalogram changes during inhalation with nitric oxide in the pediatric intensive care patient--a preliminary report.
OBJECTIVE
Although endogenous nitric oxide (NO) is an excitatory mediator in the central nervous system, inhaled NO is not considered to cause neurologic side effects because of its short half-life. This study was motivated by a recent case report about neurologic symptoms and our own observation of severe electroencephalogram (EEG) abnormalities during NO inhalation.


METHODS
Blind, retrospective analyses of EEGs which were registered before, during, and after NO inhalation. EEG was classified in a 5-point rating system by an independent electroencephalographer who was blinded to the patients' clinical histories. Comparisons were made with the previous evaluation documented at recording. Other EEG-influencing parameters such as oxygen saturation, hemodynamics, electrolytes, and pH were evaluated.


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


METHODS
Eleven ventilated, long-term paralyzed, sedated children (1 mo to 14 yrs) who had EEG or clinical assessment before NO treatment and EEG during NO inhalation. They were divided into two groups according to the NO-indication (e.g., congenital heart defect, acute respiratory distress syndrome).


RESULTS
All 11 patients had an abnormal EEG during NO inhalation. EEG-controls without NO showed remarkable improvement. EEG abnormalities were background slowing, low voltage, suppression burst (n = 2), and sharp waves (n = 2) independent of patients' age, NO-indication, and other EEG-influencing parameters.


CONCLUSIONS
These preliminary data suggest the occurrence of EEG-abnormalities after application of inhaled NO in critically ill children. We found no correlation with other potential EEG-influencing parameters, although clinical state, medication, or hypoxemia might contribute. Comprehensive, prospective, clinical assessment regarding a causal relationship between NO-inhalation and EEG-abnormalities and their clinical importance is needed.
Moenkhoff
M
M
Department of Pediatric Intensive Care, University of Zürich, Switzerland.
Schmitt
B
B
Wohlrab
G
G
Waldvogel
K
K
Fanconi
S
S
Baenziger
O
O
D000280:Administration, Inhalation; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000187:drug effects* / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
D014665:Vasodilator Agents; D009569:Nitric Oxide