INHALED NITRIC-OXIDE IN NEONATES AND CHILDREN WITH PULMONARY-HYPERTENSION

Fourteen critically ill neonatal and paediatric intensive care patient s with various primary diagnoses and signs of associated pulmonary hyp ertension received inhaled nitric oxide (NO), 20-80 ppm, after failure of conventional therapy to improve oxygenation. NO administration was found to be associated with a significant improvement in postductal a rterial oxygen tension (pre-NO: 3.75 (SD 1.39) kPa; post-NO: 6.05 (SD 1.70) kPa; p = 0.004). In 10 patients, NO was found to increase arteri al oxygen tension with more than 1 kPa. In 2 of these patients, ECMO t reatment could be avoided due to the pronounced improvement in gas exc hange seen after the initiation of NO administration. The remaining 4 patients failed to respond to NO administration. One patient developed methaemoglobinaemia (13.9%) which required treatment with methylthion ine. Since we were unable to produce any beneficial effect of NO in th e late phase of the pulmonary disease process, we believe that, in ord er to be successful, inhaled NO should be instituted when conventional treatment has failed and the administration of an iv vasodilator is u sually considered.