Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients
Autor(a) principal: | |
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Data de Publicação: | 2001 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://hdl.handle.net/11449/224193 |
Resumo: | Aim. To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings. Patients and Methods. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen < 88% while receiving a fraction of inspired oxygen (FiO2) ≥0.6 and a positive end-expiratory pressure of ≥10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mmHg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined rules. Results. At the end of the 4-hour test, all the children showed significant improvement in the PaO2/FiO2 ratio (63.6%) and the oxygenation index (44.9%) compared with the baseline values. Prolonged treatment was associated with improvement in oxygenation, so that FiO2 and peak inspiratory pressure could be quickly and significantly reduced. No toxicity from methemoglobin or nitrogen dioxide was observed. Conclusion. Administration of iNO to children is safe. iNO causes rapid and sustained improvement in oxygenation without adverse effects. Ventilator settings can safely be reduced during iNO treatment. |
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Repositório Institucional da UNESP |
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Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patientsChild welfareMechanicalMethemoglobinMultiple organ failureNitric oxideRespiratory distress syndromeVentilationAim. To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings. Patients and Methods. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen < 88% while receiving a fraction of inspired oxygen (FiO2) ≥0.6 and a positive end-expiratory pressure of ≥10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mmHg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined rules. Results. At the end of the 4-hour test, all the children showed significant improvement in the PaO2/FiO2 ratio (63.6%) and the oxygenation index (44.9%) compared with the baseline values. Prolonged treatment was associated with improvement in oxygenation, so that FiO2 and peak inspiratory pressure could be quickly and significantly reduced. No toxicity from methemoglobin or nitrogen dioxide was observed. Conclusion. Administration of iNO to children is safe. iNO causes rapid and sustained improvement in oxygenation without adverse effects. Ventilator settings can safely be reduced during iNO treatment.UNESP - Fac. de Medicina de Botucatu Departamento de Pediatria, 18.618-970 - Botucatu Sao PauloUNESP - Fac. de Medicina de Botucatu Departamento de Pediatria, 18.618-970 - Botucatu Sao PauloUniversidade Estadual Paulista (UNESP)Fioretto, J. R. [UNESP]Bonatto, R. C. [UNESP]Ricchetti, S. M.Q. [UNESP]Carpi, M. F. [UNESP]De Moraes, M. A. [UNESP]Padovani, C. R. [UNESP]2022-04-28T19:55:05Z2022-04-28T19:55:05Z2001-11-20info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article527-534Croatian Medical Journal, v. 42, n. 5, p. 527-534, 2001.0353-9504http://hdl.handle.net/11449/2241932-s2.0-0034768919Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengCroatian Medical Journalinfo:eu-repo/semantics/openAccess2022-04-28T19:55:05Zoai:repositorio.unesp.br:11449/224193Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462022-04-28T19:55:05Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
title |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
spellingShingle |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients Fioretto, J. R. [UNESP] Child welfare Mechanical Methemoglobin Multiple organ failure Nitric oxide Respiratory distress syndrome Ventilation |
title_short |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
title_full |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
title_fullStr |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
title_full_unstemmed |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
title_sort |
Early administration of inhaled nitric oxide to children with acute respiratory distress syndrome and its effects on oxygenation and ventilator settings: Prospective preliminary report of ten patients |
author |
Fioretto, J. R. [UNESP] |
author_facet |
Fioretto, J. R. [UNESP] Bonatto, R. C. [UNESP] Ricchetti, S. M.Q. [UNESP] Carpi, M. F. [UNESP] De Moraes, M. A. [UNESP] Padovani, C. R. [UNESP] |
author_role |
author |
author2 |
Bonatto, R. C. [UNESP] Ricchetti, S. M.Q. [UNESP] Carpi, M. F. [UNESP] De Moraes, M. A. [UNESP] Padovani, C. R. [UNESP] |
author2_role |
author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (UNESP) |
dc.contributor.author.fl_str_mv |
Fioretto, J. R. [UNESP] Bonatto, R. C. [UNESP] Ricchetti, S. M.Q. [UNESP] Carpi, M. F. [UNESP] De Moraes, M. A. [UNESP] Padovani, C. R. [UNESP] |
dc.subject.por.fl_str_mv |
Child welfare Mechanical Methemoglobin Multiple organ failure Nitric oxide Respiratory distress syndrome Ventilation |
topic |
Child welfare Mechanical Methemoglobin Multiple organ failure Nitric oxide Respiratory distress syndrome Ventilation |
description |
Aim. To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings. Patients and Methods. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen < 88% while receiving a fraction of inspired oxygen (FiO2) ≥0.6 and a positive end-expiratory pressure of ≥10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mmHg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined rules. Results. At the end of the 4-hour test, all the children showed significant improvement in the PaO2/FiO2 ratio (63.6%) and the oxygenation index (44.9%) compared with the baseline values. Prolonged treatment was associated with improvement in oxygenation, so that FiO2 and peak inspiratory pressure could be quickly and significantly reduced. No toxicity from methemoglobin or nitrogen dioxide was observed. Conclusion. Administration of iNO to children is safe. iNO causes rapid and sustained improvement in oxygenation without adverse effects. Ventilator settings can safely be reduced during iNO treatment. |
publishDate |
2001 |
dc.date.none.fl_str_mv |
2001-11-20 2022-04-28T19:55:05Z 2022-04-28T19:55:05Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
Croatian Medical Journal, v. 42, n. 5, p. 527-534, 2001. 0353-9504 http://hdl.handle.net/11449/224193 2-s2.0-0034768919 |
identifier_str_mv |
Croatian Medical Journal, v. 42, n. 5, p. 527-534, 2001. 0353-9504 2-s2.0-0034768919 |
url |
http://hdl.handle.net/11449/224193 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Croatian Medical Journal |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
527-534 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1803649588215676928 |