Abstract
Objective
To report the first case of ARDS in children treated with nitric oxide (NO) inhalation.
Methods
A 13-months infant presented with BPD and severe hypoxemia related to RSV infection and ARDS. Inhaled NO was delivered in the ventilatory circuit of a continuous flow ventilator (Babylog 8000, Dräger) in a concentration of 20–80 ppm for 7 days. NO and NO2 were continuously monitored (Polyton Draeger). Respiratory mechanics were evaluated by using the method of passive inflation by the ventilator.
Results
NO inhalation improved oxygenation (tcSaO2) and reduced respiratory system resistance without affecting arterial pressure. NO2 level remained below 5 ppm, and methaemoglobin level below 1%. The child survived without neurologic sequela.
Conclusions
Two mechanisms to explain oxygenation improvement can be suggested:selective improvement in perfusion of ventilated regions and bronchodilation.
Key words: Acute respiratory distress syndrome, Respiratory syncytial virus infection, Bronchopulmonary dysplasia, Nitric oxide, Child
References
- 1.La Via WV, Marks MI, Stutman HR. Respiratory syncytial virus puzzle: clinical features, pathophysiology, treatment, and prevention. J Pediatr. 1992;121:503–510. doi: 10.1016/s0022-3476(05)81135-7. [DOI] [PubMed] [Google Scholar]
- 2.Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics. 1988;82:199–203. [PubMed] [Google Scholar]
- 3.Smith DW, Frankel LR, Mathers LH, et al. A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection. N Engl J Med. 1991;325:24–29. doi: 10.1056/NEJM199107043250105. [DOI] [PubMed] [Google Scholar]
- 4.Steinhorn RH, Green TP. Use of extracorporeal membrane oxygenation in the treatment of respiratory syncytial virus bronchiolitis: the national experience, 1983 to 1988. J Pediatr. 1990;116:338–342. doi: 10.1016/s0022-3476(05)82817-3. [DOI] [PubMed] [Google Scholar]
- 5.Rossaint R, Falke KJ, Lopez F, et al. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med. 1993;328:399–405. doi: 10.1056/NEJM199302113280605. [DOI] [PubMed] [Google Scholar]
- 6.Storme L, Riou Y, Leclerc F, et al. Comparison of respiratory mechanics measurements during volume and pressure controlled ventilation in neonates. Intensive Care Med. 1992;18(Suppl 2):337. [Google Scholar]
- 7.Frostell C, Fratacci MD, Wain JC, et al. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation. 1991;83:2038–2047. doi: 10.1161/01.cir.83.6.2038. [DOI] [PubMed] [Google Scholar]
- 8.Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT, et al. Inhaled nitric oxide as a cause of selective pulmonary vasodilation in pulmonary hypertension. Lancet. 1991;338:1173–1174. doi: 10.1016/0140-6736(91)92033-x. [DOI] [PubMed] [Google Scholar]
- 9.Dupuy PM, Shore SA, Drazen JM, et al. Bronchodilator action of inhaled nitric oxide in guinea pigs. J Clin Invest. 1992;90:421–428. doi: 10.1172/JCI115877. [DOI] [PMC free article] [PubMed] [Google Scholar]