Fioretto José R, de Moraes Marcos A, Bonatto Rossano C, Ricchetti Sandra M Q, Carpi Mário F
Pediatric Intensive Care Unit, Department of Pediatrics, São Paulo State University-Unesp, Botucatu Medical School, São Paulo, Brazil.
Pediatr Crit Care Med. 2004 Sep;5(5):469-74. doi: 10.1097/01.pcc.0000137986.83738.d7.
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.
Observational study.
Pediatric intensive care unit at a university-affiliated hospital.
Children with acute respiratory distress syndrome, aged between 1 month and 12 yrs.
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.
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).
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.
确定早期吸入一氧化氮对某些氧合指标及呼吸机设置的急性和持续影响，并比较吸入一氧化氮治疗与传统疗法对急性呼吸窘迫综合征患儿死亡率、重症监护病房住院时间及机械通气时间的影响。
观察性研究。
一所大学附属医院的儿科重症监护病房。
年龄在1个月至12岁之间的急性呼吸窘迫综合征患儿。
研究分为两组：吸入一氧化氮组（iNOG，n = 18），由2000年11月至2002年11月前瞻性纳入的患者组成；传统治疗组（CTG，n = 21），由1998年8月至2000年8月收治的历史对照患者组成。
急性呼吸窘迫综合征诊断后最早在1.5小时开始吸入一氧化氮治疗，动脉血氧分压/吸入氧分数值（Pao(2)/Fio(2)）比值（提高83.7%）和氧合指数（提高46.7%）迅速改善。研究组在年龄、性别、主要诊断、儿科死亡风险评分及平均气道压方面相似。iNOG组的Pao(2)/Fio(2)比值较低（CTG组为116.9±34.5；iNOG组为62.5±12.8，p<0.0001），氧合指数较高（CTG组为15.2[范围7.2 - 32.2]；iNOG组为24.3[范围16.3 - 70.4]，p<0.0001）。延长治疗与氧合改善相关，从而能迅速且显著降低吸入氧分数值（Fio(2)）和吸气峰压。吸入一氧化氮治疗患者的死亡率较低（CTG组21例中有10例，47.6%；iNOG组18例中有3例，16.6%，p<0.001）。重症监护病房住院时间（CTG组为10天[范围2 - 49天]；iNOG组为12天[范围6 - 26天]，p>0.05）及机械通气时间（TCG组为9天[范围2 - 47天]；iNOG组为10天[范围4 - 25天]，p>0.05）无差异。
早期吸入一氧化氮治疗可使氧合得到急性和持续改善，呼吸机设置更早降低，这可能有助于降低急性呼吸窘迫综合征患儿的死亡率。重症监护病房住院时间及机械通气时间未改变。需要对儿童急性肺损伤早期吸入一氧化氮进行前瞻性试验。
