INHALED LOW-DOSE NITRIC-OXIDE FOR POSTOPERATIVE CARE IN PATIENTS WITHCONGENITAL HEART-DEFECTS

Postoperative pulmonary hypertensive crisis is a major problem that ma y account for a substantial part of the postoperative mortality and mo rbidity. We, therefore, evaluated the effect of inhalation of low-dose nitric oxide (NO) on postoperative care in pediatric patients with pu lmonary hypertension. We studied 10 infants and children ages 1-108 mo nths (median age, 11 months) with congenital heart disease associated with pulmonary hypertension. The NO and N-2 gas mixture was then mixed with varied quantities of air and oxygen and delivered into a respira tor instead of an inspiratory tube. Patients were treated with inhaled NO for 38.6 +/- 19.6 h (range 1-200 h). All patients were eventually weaned from high level sedation and respirator. The NO concentration r anged from 2 to 5 parts per million. During NO inhalation patients dem onstrated a statistically significant reduction in systolic pulmonary arterial pressure by approximately 26%; from 55 +/- 10 to 41 +/- 10 mm Hg. Inhalation of NO resulted in a significant increase of Pao(2) fro m 110 +/- 16 to 149 +/- 20 mm Hg. A-aDo(2) significantly decreased fro m 284 +/- 27 to 247 +/- 31 mm Hg. In conclusion, we have shown that a low-dose NO inhalation acted as a pulmonary vasodilator in patients wi th preexisting pulmonary hypertension.