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2009, Number 1

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Med Sur 2009; 16 (1)

Inhaled nitric oxide for the management of refractory hypoxemia in patients with acute respiratory distress syndrome

Carrillo ER, Carrillo CJR, Carrillo CLD

Language: Spanish
References: 36
Page: 4-9
PDF size: 135.04 Kb.


ABSTRACT

Background: The adult respiratory distress syndrome (ARDS) is characterized by pulmonary hypertension, right-to-left shunting of venous blood and hypoxemia. Objective: To evaluate the clinical efficacy of inhaled nitric oxide (NO) in patients with acute lung injury with refractory hypoxemia treated in the Intensive Care Unit of the Clinic Foundation Medica Sur. Methods: Ten patients with severe ARDS and refractory hypoxemia were treated with inhaled NO in progressive concentrations. Hemodynamic variables and gas exchange were measured during NO inhalation. Results: Inhalation of NO in a concentration of 25 ppm reduced the mean (± SE) pulmonary-artery pressure from 45 ± 5 mmHg to 30 ± 3 mm Hg (p ‹ 0.01) and decreased intrapulmonary shunting (Qs/Qt) from 40 ± 10% to 30 ± 5% (p ‹ 0.01). The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) or Oxigenation Index (OI), an index of the efficiency of arterial oxygenation, increased during nitric oxide administration from 150 ± 20 to 250 ± 20 mmHg (p ‹ 0.01). Conclusion: Inhaled NO in patients with severe adult respiratory distress syndrome and refractory hypoxemia reduces the pulmonary-artery pressure and intrapulmonary shunting and increases arterial oxygenation.


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