Ma. Musgrave et al., The use of inhaled nitric oxide as adjuvant therapy in patients with burn injuries and respiratory failure, J BURN CARE, 21(6), 2000, pp. 551-557
Inhaled nitric oxide (NO) is a relatively new modality in the management of
acute respiratory distress syndrome. The purpose of this study was to exam
ine our experience with inhaled NO in 10 adult patients with burn injuries
and acute respiratory distress syndrome-related oxygenation failure. The pa
tients had a mean age of 50 +/- 19 years and a mean burn size of 41% +/- 20
% of the total body surface area. Seven patients died and 3 survived. The s
urvivors and nonsurvivors did not differ with respect to age, burn size, pr
e-NO ventilator settings, or indices of oxygenation including PaO2, oxygen
saturation in arterial blood, PaO2/fraction of inspired oxygen (FIO2) ratio
, and alveolar-arterial oxygen tension difference. The concentration of NO
administered ranged between 5 ppm and 30 ppm. PaO2, oxygen saturation in ar
terial blood, and the PaO2/FIO2 ratio increased in all patients. Although i
t was not statistically significant, survivors tended to have a more vigoro
us and sustained response than nonsurvivors; this was best exemplified by t
he change in PFR. During the first hour of therapy, the PaO2/FIO2 ratio inc
reased from 64.3 +/- 12.7 to 231.8 +/- 154.5 in survivors and from 93.9 6 4
4.0 to 161.5 +/- 81.8 in the nonsurvivors. After 12 hours of therapy, the P
aO2/FIO2 ratio was 306.2 +/- 333.7 in the survivors and 178.9 +/- 69.9 in t
he nonsurvivors. There were no complications associated with the use of inh
aled NO. Although a stronger early response to NO seems to occur in survivo
rs, we cannot definitely conclude that the early response pattern is predic
tive of recovery. Nonetheless, we believe that inhaled NO has a useful role
in the treatment of patients with burn injuries and severe acute respirato
ry distress syndrome-related oxygenation failure.