Low-dose inhaled nitric oxide in acutely burned children with profound respiratory failure

Background, Inhaled nitric oxide (NO) is a rapidly acting selective pulmona ry vasodilator that partial ly reverses the pathophysiology of acute respir atory distress syndrome (ARDS). Methods. After human studies approval, we studied II burned children with s evere ARDS in a trial of inhaled NO therapy, assessing ifs effect on intrap ulmonary shunt as measured by the PaO2/FiO2 ratio (PFR). There were 12 epis odes of administration; 1 child runs treated twice. Results. The children had an average age of 8.3 +/- 4.8 years (mean +/- SEM , range II months to 14 years) and average burn size of 64% +/- 22%. Al the time of enrollment, the PFR averaged 95 +/- 50 and Murray lung score 3.1 /- 0.5. Inhaled NO was begun an average of 6.3 +/- 9.5 days after injury an d was administered for an average of 7.8 +/- 7.2 days at an average dose of 6.7 +/- 2.4 parts per million. PFR improved an average of 162% +/- 214%. E ight of the II children (73%) survived. The 3 nonsurvivors had similar admi ssion PFR values (100 +/- 75 versus 93 +/- 44, P = .089) bud a significantl y less favorable initial response to inhaled NO, with a percentage of impro vement in PFR at I hour? after enrollment of 7.3% +/- 6.4% versus 213% +/- 226% (P = .026). There were no complications,related to NO administration. Conclusions. Inhaled NO can be safely administered to treat ARDS in childre n with acute burns and appears to improve their ventilatory management. An immediate improvement in PFR with inhaled NO may correlate with survival.