title: [Inhalation of nitric oxide - dependence: case report]
abstract: OBJECTIVE: Describe the hemodynamic response with rebound of pulmonary hypertension after withdrawal of inhaled nitric oxide (NO) in a pediatric patient with acute respiratory distress syndrome (ARDS). METHODS: Case report of a child with ARDS and pulmonary hypertension evaluated through ecocardiografic with dopller, receiving inhaled NO for a period of 21 days. RESULTS: There was a decrease of the pulmonary artery pressure (PAP) from 52 mmHg to 44 mmHg after the initial titulation of NO inhalation dose. After the withdrawal of inhaled NO an elevation of PAP was observed (55 mmHg). It was necessary to reinstall the inhaled NO to obtain a more appropriate value (34 mmHg). A new attempt of interruption of the inhaled NO after prolonged inhalation (20 days) resulted in a new clinic worsening and increase of PAP, with the indication to reinstall the inhaled NO. In the 24th day of permanence in the intensive care unit the patient died due to multiple organ dysfunction. CONCLUSIONS: The possibility of pulmonary hypertension rebound after withdrawal of inhaled NO is a complication that may have important clinical implications for patients who need a prolonged treatment with NO. This case report emphasizes these implications.
authors.affiliation: Universidade Federal de São Paulo, SP, Brazil.
authors.forename: W B
authors.initials: WB
authors.lastname: Carvalho
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: S M
authors.initials: SM
authors.lastname: Horita
authors.forename: N M
authors.initials: NM
authors.lastname: Almeida
authors.forename: F R
authors.initials: FR
authors.lastname: Martins