Objective: The objective of this study was to analyze the therapeutic response to inhaled nitric oxide (NO) in children with acute respiratory distress syndrome (ARDS) and/or pulmonary hypertension (PHT).
Patients and methods: We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT, four of which had secondary ARDS. All patients presented hypoxemia and/or PHT refractory to conventional therapy. We analyzed the PaO2/FiO2 ratio, oxygenation index and mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP) before and after treatment with inhaled nitric oxide. Patients were treated with inhaled NO at 1.5 to 45 ppm between 45 minutes to 47 days.
Results: NO improved oxygenation, increasing by greater than 15% the PaO2/FiO2 ratio in 84% of the patients. In those patients which improved, PaO2 increased from 87.4 +/- 57.7 mmHg to 133.6 +/- 60.1 mmHg (p < 0.001), the PaO2/FiO2 ratio from 95.4 +/- 60.9 to 157.5 +/- 86.8 (p < 0.0001) and the oxygenation index diminished from 25.6 +/- 15.6 to 17 +/- 12.4. The PAP/SAP ratio diminished by greater than 15% in 66% of the patients, decreasing from 59.9 +/- 24.5% to 42.6 +/- 14.1% (p = 0.01).
Conclusions: Inhaled NO improved oxygenation and decreased pulmonary hypertension in an important number of children with ARDS and/or PHT.