Inhaled nitric oxide for adult respiratory distress syndrome after pulmonary resection

Background. The adult respiratory distress syndrome (ARDS) developing after pulmonary resection is usually a lethal complication. The etiology of this serious complication remains unknown despite many theories. Intubation, as piration bronchoscopy, antibiotics, and diuresis have been the mainstays of treatment. Mortality rates from ARDS after pneumonectomy have been reporte d as high as 90% to 100%. Methods. In 1991, nitric oxide became clinically available. We instituted a n aggressive program to treat patients with ARDS after pulmonary resection. Patients were intubated and treated with standard supportive measures plus inhaled nitric oxide at 10 to 20 parts/million. While being ventilated, al l patients had postural changes to improve ventilation/perfusion matching a nd management of secretions. Systemic steroids were given to half of the pa tients. Results. Ten consecutive patients after pulmonary resection with severe ARD S (ARDS score = 3.1 +/- 0.04) were treated. The mean ratio of partial press ure of arterial oxygen to the fraction of inspired oxygen at initiation of treatment was 95 +/- 13 mm Hg (mean +/- SEM) and improved immediately to 12 8 +/- 24 mm Hg, a 31% +/- 8% improvement (p < 0.05). The ratio improved ste adily over the ensuing 96 hours. Chest x-rays improved in all patients and normalized in 8. No adverse reactions to nitric oxide were observed. Conclusions. We recommend the following treatment regimen for this lethal c omplication: intubation at the first radiographic sign of ARDS; immediate i nstitution of inhaled nitric oxide (10 to 20 parts per million); aspiration bronchoscopy and postural changes to improve management of secretions and ventilation/perfusion matching; diuresis and antibiotics; and consideration of the addition of intravenous steroid therapy. (C) 1998 by The Society of Thoracic Surgeons.