Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis

• Published in: Intensive care medicine Vol. 25; no. 1; pp. 81 - 87
• Main Authors: PATEL, N. R, HAMMER, J, NICHANI, S, NUMA, A, NEWTH, C. J. L
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 1999; Berlin Springer Nature B.V; Springer-Verlag
• Subjects: Administration, Inhalation; Airway management; Albuterol - administration & dosage; Albuterol - pharmacology; Albuterol - therapeutic use; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - pharmacology; Bronchodilator Agents - therapeutic use; Children & youth; Critical care; Emergency and intensive care: neonates and children. Prematurity. Sudden death; FDA approval; Female; Hospitals; Humans; Infant; Infant, Newborn; Intensive care; Intensive care medicine; Intensive Care Units, Pediatric; Intubation; Male; Mechanics; Medical sciences; Neonatal and Pediatric Intensive Care; Nitric oxide; Nitric Oxide - administration & dosage; Nitric Oxide - pharmacology; Nitric Oxide - therapeutic use; Oxygen - blood; Pediatrics; Pilot Projects; Pneumonia; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome, Newborn - drug therapy; Respiratory Distress Syndrome, Newborn - therapy; Respiratory Distress Syndrome, Newborn - virology; Respiratory failure; Respiratory Mechanics - drug effects; Respiratory syncytial virus; Respiratory Syncytial Virus Infections - complications; Respiratory Syncytial Virus Infections - drug therapy; Respiratory Syncytial Virus Infections - therapy; Respiratory system; Ventilators; Los Angeles California; United States > US; Human respiratory syncytial virus; Intensive care; Agonist; Infant; β2-Adrenergic receptor; β-Adrenergic receptor agonist; Artificial ventilation; Paramyxoviridae; Dose activity relation; Respiratory failure; Mechanic of breathing; Bronchus disease; Complication; Salbutamol; Pneumovirus; Human; Pneumovirinae; Respiratory disease; Critically ill; Bronchodilator; Bronchiolitis; Inhalation; Infection; Virus; Mononegavirales; Chemotherapy; Treatment; Viral disease; Nitric oxide; Technique; Mechanical ventilation; Comparative study
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340050791

To evaluate the bronchodilator effect of inhaled nitric oxide (NO) in infants with respiratory failure caused by respiratory syncytial virus (RSV) bronchiolitis and to compare the effect with the one obtained by salbutamol. Prospective study. Pediatric intensive care unit of a university children's hospital. Twelve acutely ill, intubated infants (mean age 4.5 months, mean weight 4.9 kg) with respiratory failure due to documented RSV bronchiolitis. Total respiratory system resistance (Rrs) was measured by single breath occlusion at the baseline and after inhaling NO at 20, 40 and 60 ppm for 1 h, and after inhalation of a standard beta2-agonist, salbutamol. Arterial blood gas analysis was performed at each study level on 6 of the 12 patients. The baseline mean Rrs (SE) was 0.29 (0.04) cm H2O/ml per s. At each dose of NO, the mean Rrs (SE) was 0.28 (0.04) cm H2O/ml per s. With salbutamol, the mean Rrs (SE) was 0.21 (0.03) cm H20/ml per s. These values were not significantly different from each other (by ANOVA). Inhaled NO produced a significant decrease in Rrs of greater than 4 times the coefficient of variation of the baseline measurement in 3 of 12 patients. Seven of 12 patients had no significant change while two patients had a significant increase in Rrs. Inhaled salbutamol produced a significant decrease in Rrs in 5 of 11 patients, while 6 showed no change in Rrs. Inhaled NO has no apparent bronchodilator effect in the majority of acutely ill infants with RSV bronchiolitis and does not appear to provide any additional benefit over the use of salbutamol. The clinical benefit of inhaled NO as a bronchodilator is questionable under these conditions.