COMBINED NITRIC-OXIDE INHALATION, PRONE POSITIONING AND ALMITRINE INFUSION IMPROVE OXYGENATION IN SEVERE ARDS

Purpose: To determine the efficacy and side effects of prone positioni ng (PP) and nitric oxide (NO) inhalation alone, associated, or combine d with iv almitrine for the treatment of hypoxaemia in severe acute re spiratory distress syndrome (ARDS). Methods: Over a period of 20 month s, 27 consecutive critically in patients with severe ARDS (Murray scor e > 2.5, PaO2/FiO(2) < 170 after alveolar recruitment) were prospectiv ely and randomly included. They inhaled NO for two hours at concentrat ions of 5 and 10 ppm for one hour each (H0-H2). One hour later they we re returned to the prone position for four hours (H3-H7). During the l ast two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation ( Group A, n = 9), in group C (n = 9), the procedure for group B was com bined with perfusion of 16 mg.kg(-1).min(-1) almitrine throughout the study. Results: Compared with control values, two hours NO inhalation improves PaO2/FiO(2) and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28 %, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic p arameters remain unchanged, whatever the treatment, NO inhalation impr oves PaO2/FiO(2), by over 20% in 50% of the patients and PP is effecti ve in 78% of the cases. Conclusion: Prone Position improves PaO2/FiO(2 ) significantly more than NO alone but less than PPS almitrine or NOalmitrine. The best results are obtained with the association of NO Prone position + Almitrine.