Background: Inhaled nitric oxide (INO) and prone positioning have both been
advocated as methods to improve oxygenation in patients with acute respira
tory distress syndrome (ARDS), This study was designed to evaluate the rela
tive contributions of INO and prone positioning alone and in combination on
gas exchange in trauma patients with ARDS,
Methods: sixteen patients meeting the consensus definition of ARDs were stu
died. Patients received mechanical ventilation in the supine position, mech
anical ventilation plus INO at 1 part per million in the supine position, m
echanical ventilation in the PP, and mechanical ventilation in the prone po
sitioning plus INO at 1 part per million. A stabilization period of 1 hour
was allowed at each condition. After stabilization, hemodynamic and gas exc
hange variables were measured.
Results: INO and prone positioning both increased Pao(2)/FIO2, compared wit
h ventilation in the supine position. Pao(2)/FIO2 increased by 14% during u
se of INO, and 10 of 16 patients (62%) responded to INO in the supine posit
ion, Pao(2)/FIO2 increased by 33%, and 14 of 16 patients (87.5%) responded
to the prone position. The combination of INO and prone positioning resulte
d in an improvement in Pao(2)/FIO2 in 15 of 16 patients (94%), with a mean
increase in Pao(2)/FIO2 of 59%, Pulmonary vascular resistance was reduced d
uring use of INO, with a greater reduction in pulmonary vascular resistance
seen with INO plus prone positioning (175 +/- 36 dynes.s/cm(5) vs. 134 +/-
28 dynes.s/cm(5)) compared with INO in the supine position (164 +/- 48 dyn
es.s/cm(5) vs. 138 +/- 44 dynes.s/cm(5)). There were no significant hemodyn
amic effects of INO or prone positioning and no complications were seen dur
ing this relative short duration of study.
Conclusions: INO and prone positioning can contribute to improved oxygenati
on in patients with ARDs, The two therapies in combination are synergistic
and may be important adjuncts to mechanical ventilation in the ARDS patient
with refractory hypoxemia.