title: Inhaled nitric oxide improves systemic microcirculation in infants with hypoxemic respiratory failure.
abstract: OBJECTIVE
  To investigate the effect of inhaled nitric oxide on the systemic microcirculation. We hypothesized that inhaled nitric oxide improves the systemic microcirculation. Inhaled nitric oxide improves outcome in infants with persistent pulmonary hypertension of the newborn diagnosed by improving pulmonary blood flow and oxygenation. It reduces pulmonary vascular resistance without decline in systemic blood pressure. Inhaled nitric oxide is also utilized in the treatment of acute hypoxemic respiratory failure in children and adults. It is thought to improve regional ventilation perfusion by regional selective pulmonary vasodilation.
  
  
  METHODS
  Pilot study.
  
  
  METHODS
  Intensive care unit of a level III university children's hospital.
  
  
  METHODS
  Consecutive ventilated patients who were treated with inhaled nitric oxide (20 ppm) were enrolled in this study. Eight patients (five boys, three girls) were included; five had congenital diaphragmatic hernia diagnosed, one had persistent pulmonary hypertension of the newborn diagnosed, one had acute respiratory distress syndrome diagnosed, and one had bronchiolitis diagnosed. The median age was 0 months (range, 0-38 months).
  
  
  METHODS
  Inhaled nitric oxide administration.
  
  
  RESULTS
  The microcirculation was assessed in the buccal mucosa within 1 hr before and within 1 hr after the start of inhaled nitric oxide using orthogonal polarization spectral imaging. The median functional capillary density before the inhaled nitric oxide was started was 4.0 cm/cm (range, 1.8-5.6 cm/cm) and improved to 4.9 cm/cm (range, 2.8-6.6 cm/cm; p = .017) after the start of inhaled nitric oxide.
  
  
  CONCLUSIONS
  Inhaled nitric oxide improves the systemic microcirculation in children with hypoxemic respiratory failure.
authors.affiliation: Erasmus Medical Center-Sophia Children's hospital, Rotterdam, the Netherlands. anke.top@addenbrookes.nhs.uk
authors.forename: Anke P C
authors.initials: AP
authors.lastname: Top
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Patrick H M
authors.initials: PH
authors.lastname: Schouwenberg
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D009426:Netherlands; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000494:pharmacology; D010865:Pilot Projects; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology*
chemical_list: D001993:Bronchodilator Agents; D009569:Nitric Oxide