Abstract
Objective
To report the first case of ARDS in children treated with nitric oxide (NO) inhalation.
Methods
A 13-months infant presented with BPD and severe hypoxemia related to RSV infection and ARDS. Inhaled NO was delivered in the ventilatory circuit of a continuous flow ventilator (Babylog 8000, Dräger) in a concentration of 20–80 ppm for 7 days. NO and NO2 were continuously monitored (Polyton Draeger). Respiratory mechanics were evaluated by using the method of passive inflation by the ventilator.
Results
NO inhalation improved oxygenation (tcSaO2) and reduced respiratory system resistance without affecting arterial pressure. NO2 level remained below 5 ppm, and methaemoglobin level below 1%. The child survived without neurologic sequela.
Conclusions
Two mechanisms to explain oxygenation improvement can be suggested:selective improvement in perfusion of ventilated regions and bronchodilation.
Article PDF
Similar content being viewed by others
References
La Via WV, Marks MI, Stutman HR (1992) Respiratory syncytial virus puzzle: clinical features, pathophysiology, treatment, and prevention. J Pediatr 121:503–510
Groothuis JR, Gutierrez KM, Lauer BA (1988) Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics 82:199–203
Smith DW, Frankel LR, Mathers LH et al (1991) A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection. N Engl J Med 325:24–29
Steinhorn RH, Green TP (1990) Use of extracorporeal membrane oxygenation in the treatment of respiratory syncytial virus bronchiolitis: the national experience, 1983 to 1988. J Pediatr 116:338–342
Rossaint R, Falke KJ, Lopez F et al (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328:399–405
Storme L, Riou Y, Leclerc F et al (1992) Comparison of respiratory mechanics measurements during volume and pressure controlled ventilation in neonates. Intensive Care Med 18 [Suppl 2]: P 337
Frostell C, Fratacci MD, Wain JC et al (1991) Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation 83:2038–2047
Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT et al (1991) Inhaled nitric oxide as a cause of selective pulmonary vasodilation in pulmonary hypertension. Lancet 338:1173–1174
Dupuy PM, Shore SA, Drazen JM et al (1992) Bronchodilator action of inhaled nitric oxide in guinea pigs. J Clin Invest 90:421–428
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Leclerc, F., Riou, Y., Martinot, A. et al. Inhaled nitric oxide for a severe respiratory syncytial virus infection in an infant with bronchopulmonary dysplasia. Intensive Care Med 20, 511–512 (1994). https://doi.org/10.1007/BF01711907
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01711907