WEANING STRATEGY WITH INHALED NITRIC-OXIDE TREATMENT IN PERSISTENT PULMONARY-HYPERTENSION OF THE NEWBORN

Aim-To determine if infants who had become dependent on inhaled nitric oxide treatment could be successfully weaned off it if FIO2 was incre ased briefly during withdrawal. Methods-Sixteen infants admitted for c onditions associated with increased pulmonary vascular resistance resp onded well to inhaled nitric oxide treatment with a significant increa se in PaO2 (maximum inhaled nitric oxide given 25 ppm). Weaning from i nhaled nitric oxide in 5 ppm decrements was initiated once the FIO2 re quirement was less than 0.5. When patients were stable on 5 ppm of inh aled nitric oxide, the gas was then discontinued. If a patient showed inhaled nitric oxide dependence-that is, oxygen saturation fell by mor e than 10% or below 85%-inhaled nitric oxide was reinstated at 5 ppm a nd the patient allowed to stabilise for 30 minutes. At this time, FIO2 was increased by 0.40 and weaning from inhaled nitric oxide was attem pted again. Results-Nine infants were successfully weaned on the first attempt. The seven infants who failed the initial trial were all succ essfully weaned following the increase in FIO2. After successful weani ng, FIO2 was returned to the pre-weaning level in mean 148(SD 51) minu tes and inhaled nitric oxide was never reinstated. Conclusion-Infants showing inhaled nitric oxide dependency can be successfully weaned by increasing FIO2 transiently.