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VOLUME 10 , ISSUE 2 ( April, 2006 ) > List of Articles

RESEARCH ARTICLE

Acute effects of nitric oxide inhalation in ARDS: A dose finding study at steady state kinetics

M. S. Hari, A. Trikha, R. Madan, H. L. Kaul

Keywords : ARDS, nitric oxide, acute effects

Citation Information : Hari MS, Trikha A, Madan R, Kaul HL. Acute effects of nitric oxide inhalation in ARDS: A dose finding study at steady state kinetics. Indian J Crit Care Med 2006; 10 (2):75-79.

DOI: 10.4103/0972-5229.25919

License: CC BY-ND 3.0

Published Online: 01-04-2006

Copyright Statement:  Copyright © 2006; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Inhaled Nitric oxide (INO) decreases pulmonary artery pressures and improves oxygenation in patients with ARDS. Aim: To evaluate the dose response to 1-20 parts per million (ppm) INO in ARDS, by noting changes in oxygenation, pulmonary artery systolic pressures (PASP) and to determine optimum dose. Methodology and Design: Prospective study. Setting: 10 bed general intensive care unit. Patients: 13 consecutive patients with ARDS. Interventions: INO was given between 1-20 ppm with 15 minutes at each concentration via an insufflator from a high pressure source, to the inspiratory limb of the ventilator. Study had ascending and descending phase. Results and Conclusions: The optimum dose of INO to improve oxygenation was between 3 and 10 ppm. PaO2 improvement was independent of pulmonary haemodynamic changes. The pulmonary haemodynamic changes needed higher INO initially. Once stabilized, INO could be brought down to concentrations at which maximum improvement in PaO2 occurred. The ′responders′ had lesser duration of pre INO ventilation and lower PaO2/FiO2.


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  1. The Acute Respiratory Distess Syndrome network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for Acute Lung Injury and Acute respiratory Distress syndrome. N Engl J Med 2000;342;1301-8.
  2. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS: Definitions, mechanism, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med 1994;149;818-24.
  3. The National Heart, Lung and Blood Institute ARDS clinical Trials Network. High versus Low positive end expiratory pressures in patients with the Acute Respiratory Distress Syndrome. N Engl J Med 2004;351:327-36.
  4. Bigatello LM, Huford WE, Kacmarek RM, Roberts JD Jr, Zapol WM. Prolonged inhalation of low concentration of nitric oxide in patients with severe adult respiratory distress syndrome. Anesthesiology 1994;80:761-70.
  5. Rossaint R, Gerlach H, Schmidt RH, Pappert D, Lewandowski K, Steudel W, et al. Efficacy of inhaled nitric oxide in patient with severe ARDS. Chest 1995;107:1107-15.
  6. Gerlach H, Rossaint R, Pappert D, Falke KJ. Time-course and dose-response of nitric oxide inhalation for systemic oxygenation and pulmonary hypertension in patients with adult respiratory distress syndrome. Eur J Clin Invest 1993;23:499-502.
  7. Gerlach H, Pappert D, Lewandowski K, Rossaint R, Falke KJ. Long term inhalation with evaluated low doses of nitric oxide for selective improvement of oxygenation in patients with adult respiratory distress syndrome. Intensive Care Med 1993;19:443-9.
  8. Lundin S, Mang H, Smithies M, Stenqvist O, Frostell C. Inhalation of nitric oxide in acute lung injury: results of European multicentre study. The European study group of inhaled nitric oxide. Intensive Care Med 1999;25:911-9.
  9. Treggiari-Venzi M, Ricou B, Romand JA, Suter PM. The response to repeated nitric oxide inhalation is inconsistent in patients with acute respiratory distress syndrome. Anesthesiology 1998;88:634-41.
  10. Johannigam JA, Davis K Jr, Campbell Rs, 0 Luchette F, Hurst JM, Branson RD. Inhaled nitric oxide in acute respiratory distress syndrome. J Trauma 1997;43:904-9.
  11. Lowson SM, Rich GF, McArdle PA, Jaidev J, Morris GN. The response to varying concentration of inhaled nitric oxide in patients with acute respiratory distress syndrome. Anesthesia Analgesia 1996;82:574-81.
  12. Rossetti M, Guenard H, Gabinski C. Effect of nitric oxide inhalation on pulmonary serial vascular resistance in ARDS. Am J Respirat Crit Care Med 1996;154:1375-81.
  13. Iotti GA, Olivei MC, Palo A, Galbusera C, Veronesi R, Braschi A. Acute effects of inhaled nitric oxide in adult respiratory distress syndrome. Eur Respir J 1998;12:1164-71.
  14. Puybasset L, Rouby JJ, Mouregeon E. Factors influencing cardiopulmonary effects of inhaled nitric oxide in acute respiratory failure. Am J Respir Care Med 1995;152:318-28.
  15. Luyt S, Coetzee A, Lahner D, Jansen J. Nitric oxide has little effect on acute pulmonary hypertension and right ventricular function during acute respiratory distress syndrome. S Afr Med J 1997;87:693-42.
  16. Lundin S, Westfelt UN, Stenqvist O, Blomqvist H, Lindh A, Berggren L, et al. Response to nitric oxide inhalation in early acute lung injury. Intensive Care Med 1996;22:728-34.
  17. Manktelow C, Bigatello LM, Hess D, Hurford WE. Physiological determinants of the response to inhaled nitric oxide in patients with acute respiratory distress syndrome. Anesthesiology 1997;87:297-307.
  18. Dupont H, Le Corre F, Fierobe L. Efficacy of inhaled nitric oxide as rescue therapy during severe ARDS: Survival and factor associated with first response. J Crit Care 1999;14:7-13.
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