[Effect of inhaled nitric oxide on the first 24 hours of assisted respiration in the critically ill child].

OBJECTIVE

Our aim was to analyze if inhaled nitric oxide (NO) allows a reduction in respiratory assistance during the first 24 hours of treatment of children with acute respiratory distress syndrome (ARD) and/or pulmonary hypertension (PHT).

PATIENTS AND METHODS

We studied 53 children with ARDS and/or PHT refractory to conventional therapy who were treated with inhaled nitric oxide at least 24 hours at 1.5 to 45 ppm. We compared respiratory assistance (peak pressure, PEEP and FiO2) and oxygenation parameters (PaO2/FiO2 ratio and oxygenation index) before and after 6 and 24 hours of treatment.

RESULTS

In 45 of 53 children NO improved oxygenation (increase of PaO2/FiO2 > 20%). At six hours of treatment the PaO2/FiO2 ratio increased 31 points, the oxygenation index diminished 4.5 points, and the FiO2 was decreased 11 points without significant changes in peak pressure and PEEP. At 24 hours the PaO2/FiO2 ratio was increased 4 points, the oxygenation index diminished 7.3 points and the FiO2 decreased 18 points in relationship to the initial parameters.

CONCLUSIONS

The effect of inhaled nitric oxide on oxygenation remains during the first 24 hours and permits a decrease in the FiO2.