Canadian Journal of Anesthesia

, Volume 49, Issue 3, pp 315–318

Rescue therapy with inhaled nitric oxide in critically ill patients with severe hypoxemic respiratory failure (Brief report)

  • Fred J. Baxter
  • Jill Randall
  • John D. Miller
  • David A. Higgins
  • A. C. Peter Powles
  • Peter T. -L. Choi
Neuroanesthesia and Intensive Care

Abstract

Purpose

To evaluate the efficacy of inhaled nitric oxide (iNO) on oxygenation, shunt, and pulmonary vascular resistance index (PVRI) in severely hypoxemic, ventilated patients.

Methods

In a two-period double-blind crossover design, 14 critically ill, hypoxemic, ventilated patients were randomized to receive iNO 10 ppm in 100% oxygen or no iNO in 100% oxygen for 30 min followed by a 30-min washout period and then crossed over to the other intervention. Responders to iNO then received iNO, which was increased from 5 ppm to 25 ppm in 5 ppm increments. Severity of illness scores and cardiorespiratory variables were measured.

Results

Nitric oxide decreased shunt (P = 0.002) and PVBI (P = 0.033) and increased oxygenation (P = 0.011) although the latter two were not statistically significant after adjustment for multiple comparisons. Treatment by period interactions were observed.

Conclusion

Our findings suggest that iNO improves oxygenation to a clinically significant extent in critically ill patients who are severely hypoxemic.

Thérapie de secours par l’inhalation d’oxyde nitrique chez de grands malades atteints d’insuffisance respiratoire hypoxémique

Zusammenfassung

Objectif

Évaluer l’efficacité de l’inhalation d’oxyde nitrique (iNO) sur l’oxygénation, le shunt et l’index de résistance vasculaire pulmonaire (IRVP) chez des sujets atteints d’hypoxémie sévère et placés sous ventilation.

Méthode

Une étude de type croisée, à double insu et en deux temps a été réalisée auprès de 14 grands malades hypoxémiques placés sous ventilation. On les a répartis au hasard pour recevoir 10 ppm de iNO dans 100 % d’oxygène ou 100 % d’oxygène sans iNO pendant 30 min suivies d’une élimination de 30 min et de la permutation des interventions. Les sujets répondants à l’iNO ont alors reçu de l’iNO qui a été augmenté de 5 ppm à 25 ppm par paliers de 5 ppm. La sévérité de la maladie et des variables cardiorespiratoires a été mesurée.

Résultats

L’oxyde nitrique a réduit le shunt (P = 0,002) et l’IRVP (P = 0,033) et augmenté l’oxygénation (P = 0,011) bien que ces deux dernières modifications n’étaient pas statistiquement significatives à la suite d’un ajustement pour comparaisons multiples. Le traitement par période d’interactions a été étudié.

Conclusion

Nos résultats indiquent que l’iNO améliore l’oxygénation clinique de façon significative chez les grands malades souffrant d’hypoxémie sévère.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Fred J. Baxter
    • 1
  • Jill Randall
    • 3
  • John D. Miller
    • 5
  • David A. Higgins
    • 2
  • A. C. Peter Powles
    • 2
    • 4
  • Peter T. -L. Choi
    • 1
  1. 1.Department of AnaesthesiaSt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  2. 2.Department of MedicineSt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  3. 3.Department of Respiratory TherapySt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  4. 4.Divisions of Critical Care MedicineSt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  5. 5.Department of Thoracic SurgerySt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  6. 6.Department of AnaesthesiaSt. Joseph’s HospitalHamiltonCanada

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