Management of postoperative chylothorax with nitric oxide: a case report.
OBJECTIVE
To describe the use of inhaled nitric oxide in the management of refractory postoperative chylothorax.


METHODS
Case report.


METHODS
A pediatric intensive care unit of a tertiary care children's hospital.


METHODS
A neonate with refractory chylothoraces complicated by moderate pulmonary hypertension after a complicated arterial switch operation.


METHODS
Administration of inhaled nitric oxide through a ventilator circuit.


RESULTS
The institution of inhaled nitric oxide at 20 ppm resulted in a marked reduction in chest tube drainage and a decrease in echocardiographically estimated pulmonary artery pressure from 50%-75% systemic to 30%-50% systemic. Chest tube drainage doubled when the nitric oxide was decreased to 10 ppm and, again, dramatically decreased after raising nitric oxide back to 20 ppm. After 8 days of nitric oxide therapy, the chest tube drainage ceased. Nitric oxide therapy was successfully discontinued 19 days after initiation, with no recurrence of chylothorax. There was no effect of nitric oxide on systemic blood pressure. Methemoglobin levels while on NO remained <1.7%.


CONCLUSIONS
Consideration may be given to the use of inhaled nitric oxide in the therapy of refractory chylothoraces complicated by central venous hypertension.
Berkenbosch
J W
JW
Department of Pediatric Critical Care, Montreal Children's Hospital, McGill University, Quebec, Canada.
Withington
D E
DE
D000280:Administration, Inhalation; D015505:Chest Tubes; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D004322:Drainage; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D011859:Radiography; D014188:Transposition of Great Vessels / Q000601:surgery; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009569:Nitric Oxide