Management of postoperative chylothorax with nitric oxide: A case report

Objective: To describe the use of inhaled nitric oxide in the management of refractory postoperative chylothorax. Design: Case report. Setting: A pediatric intensive care unit of a tertiary care children's hosp ital. Patient: A neonate with refractory chylothoraces complicated by moderate pu lmonary hypertension after a complicated arterial switch operation. Interventions: Administration of inhaled nitric oxide through a ventilator circuit. Measurements and Main Results: The institution of inhaled nitric oxide at 2 0 ppm resulted in a marked reduction in chest tube drainage and a decrease in echocardiographically estimated pulmonary artery pressure from 50%-75% s ystemic to 30%-50% systemic. Chest tube drainage doubled when the nitric ox ide was decreased to 10 ppm and, again, dramatically decreased after raisin g nitric oxide back to 20 ppm. After 8 days of nitric oxide therapy, the ch est tube drainage ceased. Nitric oxide therapy was successfully discontinue d 19 days after initiation, with no recurrence of chylothorax. There was no effect of nitric oxide on systemic blood pressure. Methemoglobin levels wh ile on NO remained <1.7%. Conclusion: Consideration may be given to the use of inhaled nitric oxide i n the therapy of refractory chylothoraces complicated by central venous hyp ertension.