在接受吸入一氧化氮治疗的危重症儿科患者中，常规高铁血红蛋白实验室检测的效用。

Utility of routine methemoglobin laboratory assays in critically ill pediatric subjects receiving inhaled nitric oxide.

机构信息

Department of Pharmacy Services, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, USA.

Section of Pediatric Cardiac Intensive Care, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN, USA; Department of Pediatrics, Indiana University School of Medicine, 340 W. 10th St. #6200, Indianapolis, IN, USA.

出版信息

J Crit Care. 2018 Dec;48:63-65. doi: 10.1016/j.jcrc.2018.08.014. Epub 2018 Aug 18.

DOI:10.1016/j.jcrc.2018.08.014

PMID:30172035

Abstract

PURPOSE

Inhaled nitric oxide (iNO) has been associated with safety risks including reports of methemoglobinemia. While standard of care recommends routine monitoring of methemoglobin in subjects on iNO therapy, the utility of this practice remains unknown.

MATERIALS AND METHODS

This retrospective chart review aimed to determine the frequency of methemoglobinemia in pediatric patients receiving iNO. Included subjects were under 18 years of age receiving iNO therapy with at least one methemoglobin concentration measured from 10/18/2014 to 11/18/2016.

RESULTS

In total, 1809 methemoglobin concentrations were collected in 247 subjects during the study period. Median age was 0.33 (0.04-0.83) years. The mean methemoglobin concentration was 1.33% (±0.42) while receiving a mean iNO dose of 11.71 ppm (±7.97). Twenty-nine subjects had a total of 131 methemoglobin concentrations analyzed while receiving iNO doses above 20 ppm which were similar to the entire cohort at 1.33% (±0.42); (p = .95).

CONCLUSIONS

Pediatric patients receiving iNO at doses below 40 ppm have minimal risk of developing clinically significant methemoglobinemia. Routine, ongoing monitoring of metHb levels in all pediatric subjects receiving iNO therapy at doses <40 ppm without the presence of risk factors predisposing the subject to increased risk of methemoglobinemia is unnecessary and should be avoided.

摘要

目的

吸入一氧化氮（iNO）与高铁血红蛋白血症等安全风险相关。虽然标准治疗建议对接受 iNO 治疗的患者常规监测高铁血红蛋白，但这种做法的实用性仍不清楚。

材料和方法

本回顾性图表研究旨在确定接受 iNO 治疗的儿科患者高铁血红蛋白血症的频率。纳入的研究对象为年龄在 18 岁以下，在 2014 年 10 月 18 日至 2016 年 11 月 18 日期间接受 iNO 治疗且至少有一次高铁血红蛋白浓度测量值的患者。

结果

在研究期间，共有 247 例患者共采集了 1809 次高铁血红蛋白浓度值。中位年龄为 0.33 岁（0.04-0.83 岁）。平均高铁血红蛋白浓度为 1.33%（±0.42），同时接受平均 iNO 剂量为 11.71 ppm（±7.97）。29 例患者共接受了 131 次 iNO 剂量超过 20 ppm 的高铁血红蛋白浓度分析，与整个队列相似，为 1.33%（±0.42）；（p=0.95）。