Combination of inhaled nitric oxide therapy and inverse ratio ventilation in patients with sepsis-associated acute respiratory distress syndrome.
Inverse ratio ventilation (IRV) is a ventilatory technique that uses an inspiratory to expiratory ratio (I:E) greater than 1:1. We studied the effects of mechanical ventilation with an I:E of 1:3, 1:1, and 2:1 on arterial oxygenation in 10 patients with sepsis-associated acute respiratory distress syndrome (ARDS). At each I:E, patients received 0 and 4 ppm of inhaled nitric oxide (INO) in random order for 30 min. Respiratory and cardiovascular parameters were measured. Of the 10 patients studied, 7 responded to IRV and 3 did not. An increase in the I:E and the addition of INO significantly improved arterial oxygenation in the responders (p < 0. 0001 and p < 0.006, respectively). The combination of an increase in the I:E and INO had an additive effect on arterial oxygenation. The combined use of IRV and INO is a more effective method of avoiding hypoxemia than either INO or IRV alone.
Okamoto
K
K
Division of Intensive and Critical Care Medicine, Kumamoto University School of Medicine, Kumamoto, Japan. kami@kaiju.medic.kumamoto-u.ac.jp
Kukita
I
I
Hamaguchi
M
M
Kikuta
K
K
Matsuda
K
K
Motoyama
T
T
D000280:Administration, Inhalation; D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000403:Airway Resistance / Q000502:physiology; D000704:Analysis of Variance; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D007320:Inspiratory Capacity / Q000502:physiology; D008297:Male; D008451:Maximal Voluntary Ventilation / Q000502:physiology; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011312:Pressure; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D018805:Sepsis / Q000150:complications*
D001993:Bronchodilator Agents; D002245:Carbon Dioxide; D009569:Nitric Oxide; D010100:Oxygen