Randomised trial of three doses of inhaled nitric oxide in acute respiratory distress syndrome
Department of Intensive Care, Royal Alexandra Hospital
for Children, Sydney, NSW 2145, Australia
Correspondence to: Dr Owen I Miller, Cardiothoracic Unit, Great Ormond Street Hospital for Sick Children NHS Trust, London WC1N 3JH, UK. email: Owen.Miller{at}gosh-tr.nthames.nhs.uk
Accepted 11
May 1998
BACKGROUND
Inhaled nitric oxide (iNO) is a
potential therapeutic agent for the management of acute respiratory
distress syndrome (ARDS). Concerns remain, however, regarding the
potential toxicity from iNO and/or its oxidative derivatives and methaemoglobinaemia.
AIMSTo determine the risk of toxicity from iNO,
which includes worsening of lung injury, a prospective study evaluating
the acute effects of three concentrations of iNO on gas exchange and
haemodynamics in 12 children with ARDS was performed in a tertiary
paediatric intensive care unit.
INTERVENTIONiNO was administered for one hour at
three concentrations (1, 10, and 20 parts per million (ppm)) in a
random order of possible dosing schedules to avoid dose accumulation
bias. Arterial blood gas, methaemoglobin concentrations, and
haemodynamic parameters were obtained at baseline before commencement
of iNO, at the end of each study hour, and after iNO was discontinued.
Nitric oxide and nitrogen dioxide concentrations were continuously
monitored during the study.
RESULTSiNO significantly improved the oxygenation
ratio (PaO2/FiO2) from
a mean (SEM) baseline of 11.9 (1.7) kPa to 20 (3.9) kPa, 24 (4.5) kPa, and 21.6 (3.9) kPa at 1, 10, and 20 ppm iNO,
respectively. There was no significant difference in the improvement in
oxygenation achieved between the three concentrations. Correspondingly,
there was a significant improvement in oxygenation index (pre-iNO 28.3 (5) v post-iNO 18 (3) (1 ppm), 15 (3) (10 ppm), 16 (3) (20 ppm)). No toxicity from methaemoglobinaemia or
nitrogen dioxide was seen during iNO administration.
CONCLUSIONThe results show that a low
concentration of iNO (1 ppm) is as effective as higher concentrations
(10 and 20 ppm) in improving oxygenation in children with ARDS and may
be important in minimising toxicity during iNO use.
© 1998 by Archives of Disease in Childhood
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