Anest. intenziv. Med. 2009;20(4):176-184

iNO in acute respiratory failure of the newborns. A comparison of its combination with CMV and HFOVIntensive Care Medicine - Original Paper

Lukáš Marek^1,*, Vobruba Václav², Košut Peter¹, Srnský Pavel², Žurek Jiří¹, Koudelková Ludmila¹, Košinová Lucie¹, Fedora Michal¹

¹ Klinika dětské anesteziologie a resuscitace Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno

² Jednotka intenzivní a resuscitační péče Kliniky dětského a dorostového lékařství Všeobecné fakultní nemocnice v Praze

Objective:
To compare the effect of inhaled nitric oxide (iNO) combined with conventional mechanical ventilation (CMV) or high-frequency oscillatory ventilation (HFOV) on oxygenation and ventilation parameters, complications rates and mortality in newborns with acute hypoxic respiratory failure (AHRF).

Design:
A prospective observational study.


Setting:
The Paediatric Anaesthesia and Intensive Care Clinic, University Hospital Brno, and The Paediatric and Adolescent Medicine Clinic, General University Hospital, Prague.

Materials and methods:
We enrolled in the study newborns with persistent pulmonary hypertension (PPHN) or acute respiratory distress syndrome (ARDS) without congenital heart disease in whom CMV or HFOV had failed. The newborns were divided in the CMV or HFOV groups according to the type of ventilation during iNO therapy. We recorded the following characteristics: the demographic data, duration of hospitalization, mechanical ventilation and iNO therapy, ARDS origin, diagnosis, outcome, iNO concentration; oxygenation, ventilation and acid-base parameters, ventilator settings and complications due to iNO.

Results:
We enrolled 25 newborns. We recorded a temporary improvement in oxygenation in both the groups and in particular in the HFOV group. We did not record any improvement in the ventilation and acid-base parameters. We did not observe an effect on the ventilator settings except for a comparable decrease of FiO₂ in both the groups. We did not record any adverse effects. Total mortality was 4%.

Conclusion:
Both the therapeutic combinations improve oxygenation in the newborns with AHRF. HFOV has an additive effect on oxygenation. Either combination did not influence the ventilation or acid-base parameters. Both the methods provided for a similar reduction of FiO₂ with no effect on the other ventilator settings. We observed the same low probability of adverse effects of administering iNO up to 20 ppm in both combinations. Either combination did not influence the mortality in neonates with AHRF.

Keywords: nitric oxide; newborns; Acute Respiratory Failure; oxygenation; Conventional Mechanical Ventilation; High Frequency Oscilatory Ventilation

Received: November 20, 2008; Accepted: May 16, 2009; Published: August 1, 2009  Show citation