Nitrogen Oxide in the Treatment of the Acute Distress Syndrome
Cvachovec K., Romportl D., Havelka Z., Pelichovská M.,Hladíková M.
Klinika anesteziologie a resuscitace 2. LF UK a FNM, Praha Ústav lékařské informatiky 2. LF UK, Praha |
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Summary:
Background. Nitric oxide (NO) is a selective pulmonary vasodilator effective in the treatment of pulmonary
hypertension and hypoxemic respiratory failure. Reports in the Czech literature on the results of its therapeutic use
are still scarce.
Methods and Results. Effects of inhaled NO on the changes of PaO 2 /FiO 2 were assessed in the retrospective
study. Records of artificially ventilated patients suffering from acute respiratory distress syndrome (ARDS) were
reviewed. Daily highest NO dose, the highest PaO 2 /FiO 2 ratio, duration of NO administration and death or survival
of the patient was noted. Survivors and nonsurvivors, as well as responders (rise of PaO 2 /FiO 2 by at least 20 %) and
non-responders were compared using Mann-Whitney and ANOVA test, a=0.05. 16 patients were entered into the
study, 13 (81 %) responded positively to NO administration, the mortality was 56 %. Comparing the age, NO dose,
duration of its administration and APACHE II score in survivors and non-survivors, in respondents and non-res -
pondents no differences were found. After NO administration the PaO 2 /FiO 2 rose both in survivors and non-survivors
(p<0.0005). In survivors the response of oxygenation was more pronounced, although the difference did not reach
the statistical significance (p=0.07). On the days 1–3 the PaO 2 /FiO 2 ratio was higher in survivors (p<0.05).
Conclusions. Despite the transient increase in oxygenation after NO administration, mortality of patients with
ARDS remained high. NO administration could not be considered the standard method of treatment of patients with
ARDS in intensive care.
Key words:
nitric oxide, acute respiratory distress syndrome, hypoxemia, intensive care.
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