title: Additive effect of nitric oxide inhalation on the oxygenation benefit of the prone position in the adult respiratory distress syndrome.
abstract: BACKGROUND
  The response to inhaled nitric oxide and prone positioning was investigated in 47 patients with adult respiratory distress syndrome to test the hypothesis that inhalation of nitric oxide when in the prone position would result in additive improvement in oxygenation.
  
  
  METHODS
  The authors prospectively studied patients of both genders who were 15 to 75 yr old and had adult respiratory distress syndrome confirmed by computed tomography (lung injury score, 3.1+/-1).
  
  
  RESULTS
  Compared with baseline values in the supine position (T1), inhalation of 10 ppm nitric oxide for 1 h (T2) decreased the mean pulmonary artery pressure from 33+/-9 mmHg to 28+/-6 mmHg (P < 0.05; T2 vs. T1) and increased the ratio of the partial pressure of oxygen in arterial blood (PaO2) to inspired oxygen concentration (FiO2) from 115 (median first quartile [Q1] 97, median third quartile [Q3] 137) to 148 (Q1 132, Q3 196) (P < 0.05; T2 vs. T1). Cessation of nitric oxide brought the values back to baseline (T3). Two hours of prone positioning (T4) significantly increased the PaO2:FiO2 ratio (T4 vs. T3). However, after an additional hour of nitric oxide inhalation in the prone position (T5), a significant decrease of the venous admixture (from 33+/-6% to 25+/-6%; P < 0.05) and an increase of the PaO2:FiO2 ratio (from 165 [Q1 129, Q3 216] to 199 [Q1 178, Q3 316] [P < 0.05; T5 vs. T4]) were observed.
  
  
  CONCLUSIONS
  In patients with isolated severe adult respiratory distress syndrome, inhalation of nitric oxide in the prone position significantly improved oxygenation compared with nitric oxide inhalation in the supine position or in the prone position without nitric oxide. The combination of the prone position with nitric oxide inhalation in the treatment of severe adult respiratory distress syndrome should be considered.
authors.affiliation: Department of Anesthesiology and General Intensive Care, University of Vienna, Austria. peter.germann@univie.ac.at
authors.forename: P
authors.initials: P
authors.lastname: Germann
authors.forename: G
authors.initials: G
authors.lastname: Pöschl
authors.forename: C
authors.initials: C
authors.lastname: Leitner
authors.forename: G
authors.initials: G
authors.lastname: Urak
authors.forename: R
authors.initials: R
authors.lastname: Ullrich
authors.forename: B
authors.initials: B
authors.lastname: Faryniak
authors.forename: G
authors.initials: G
authors.lastname: Röder
authors.forename: A
authors.initials: A
authors.lastname: Kaider
authors.forename: R
authors.initials: R
authors.lastname: Sladen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D012129:Respiratory Function Tests; D016683:Supine Position / Q000502:physiology; D014057:Tomography, X-Ray Computed
chemical_list: D009569:Nitric Oxide; D010100:Oxygen