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Inhaled nitric oxide improves systemic microcirculation in infants with hypoxemic respiratory failure

Top, Anke P. C. MD, FRCPH, PhD; Ince, Can PhD; Schouwenberg, Patrick H. M. MD; Tibboel, Dick MD, PhD

Pediatric Critical Care Medicine: November 2011 - Volume 12 - Issue 6 - p e271-e274
doi: 10.1097/PCC.0b013e31820ac0b3
Online Clinical Investigations

Objectives: To investigate the effect of inhaled nitric oxide on the systemic microcirculation. We hypothesized that inhaled nitric oxide improves the systemic microcirculation. Inhaled nitric oxide improves outcome in infants with persistent pulmonary hypertension of the newborn diagnosed by improving pulmonary blood flow and oxygenation. It reduces pulmonary vascular resistance without decline in systemic blood pressure. Inhaled nitric oxide is also utilized in the treatment of acute hypoxemic respiratory failure in children and adults. It is thought to improve regional ventilation perfusion by regional selective pulmonary vasodilation.

Design: Pilot study.

Setting: Intensive care unit of a level III university children's hospital.

Patients: Consecutive ventilated patients who were treated with inhaled nitric oxide (20 ppm) were enrolled in this study. Eight patients (five boys, three girls) were included; five had congenital diaphragmatic hernia diagnosed, one had persistent pulmonary hypertension of the newborn diagnosed, one had acute respiratory distress syndrome diagnosed, and one had bronchiolitis diagnosed. The median age was 0 months (range, 0–38 months).

Interventions: Inhaled nitric oxide administration.

Measurements and Main Results: The microcirculation was assessed in the buccal mucosa within 1 hr before and within 1 hr after the start of inhaled nitric oxide using orthogonal polarization spectral imaging. The median functional capillary density before the inhaled nitric oxide was started was 4.0 cm/cm2 (range, 1.8–5.6 cm/cm2) and improved to 4.9 cm/cm2 (range, 2.8–6.6 cm/cm2; p = .017) after the start of inhaled nitric oxide.

Conclusions: Inhaled nitric oxide improves the systemic microcirculation in children with hypoxemic respiratory failure.

From the Intensive Care Unit (APCT, PHMS, DT), Erasmus Medical Center-Sophia Children's hospital, Rotterdam, the Netherlands; Pediatric Intensive Care Unit (APCT), Addenbrookes Hospital, Cambridge, United Kingdom; Intensive Care Unit (CI), Erasmus Medical Center, Rotterdam, the Netherlands.

The authors have not disclosed any potential conflicts of interest.

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©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies