Acute and sustained effects of early administration of inhaled nitric oxide to children with acute respiratory distress syndrome.
OBJECTIVE
To determine the acute and sustained effects of early inhaled nitric oxide on some oxygenation indexes and ventilator settings and to compare inhaled nitric oxide administration and conventional therapy on mortality rate, length of stay in intensive care, and duration of mechanical ventilation in children with acute respiratory distress syndrome.


METHODS
Observational study.


METHODS
Pediatric intensive care unit at a university-affiliated hospital.


METHODS
Children with acute respiratory distress syndrome, aged between 1 month and 12 yrs.


METHODS
Two groups were studied: an inhaled nitric oxide group (iNOG, n = 18) composed of patients prospectively enrolled from November 2000 to November 2002, and a conventional therapy group (CTG, n = 21) consisting of historical control patients admitted from August 1998 to August 2000.


RESULTS
Therapy with inhaled nitric oxide was introduced as early as 1.5 hrs after acute respiratory distress syndrome diagnosis with acute improvements in Pao(2)/Fio(2) ratio (83.7%) and oxygenation index (46.7%). Study groups were of similar ages, gender, primary diagnoses, pediatric risk of mortality score, and mean airway pressure. Pao(2)/Fio(2) ratio was lower (CTG, 116.9 +/- 34.5; iNOG, 62.5 +/- 12.8, p <.0001) and oxygenation index higher (CTG, 15.2 [range, 7.2-32.2]; iNOG, 24.3 [range, 16.3-70.4], p <.0001) in the iNOG. Prolonged treatment was associated with improved oxygenation, so that Fio(2) and peak inspiratory pressure could be quickly and significantly reduced. Mortality rate for inhaled nitric oxide-patients was lower (CTG, ten of 21, 47.6%; iNOG, three of 18, 16.6%, p <.001). There was no difference in intensive care stay (CTG, 10 days [range, 2-49]; iNOG, 12 [range, 6-26], p >.05) or duration of mechanical ventilation (TCG, 9 days [range, 2-47]; iNOG, 10 [range, 4-25], p >.05).


CONCLUSIONS
Early treatment with inhaled nitric oxide causes acute and sustained improvement in oxygenation, with earlier reduction of ventilator settings, which might contribute to reduce the mortality rate in children with acute respiratory distress syndrome. Length of stay in intensive care and duration of mechanical ventilation are not changed. Prospective trials of inhaled nitric oxide early in the setting of acute lung injury in children are needed.
Pediatric Intensive Care Unit, Department of Pediatrics, São Paulo State University-Unesp, Botucatu Medical School, São Paulo, Brazil. jrf@fmb.unesp.br
José R
JR
Fioretto
Marcos A
MA
de Moraes
Rossano C
RC
Bonatto
Sandra M Q
SM
Ricchetti
Mário F
MF
Carpi
D000280:Administration, Inhalation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015278:Intensive Care Units, Pediatric; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D010101:Oxygen Consumption / Q000502:physiology*; D011336:Probability; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D009569:Nitric Oxide