Abstract
Rationale. The nitrogen oxide molecule (NO) is a fundamental factor of the anti-infectious resistance of an organism. Research objective. To evaluate the effectiveness and safety of the prevention of sepsis by the inhalation of nitrogen oxide (iNO) in newborns with respiratory pathology on artificial pulmonary ventilation. Methods. Controlled, randomized, blind clinical trial included 97 newborns with respiratory pathology for artificial pulmonary ventilation. Patients received standard intensive therapy. The main group (n=44) received inhaled nitrogen oxide. The control group (n=53) did not receive inhaled nitrogen oxide. On Days 1, 3, and 20, the plasma concentrations of IL-1ß, IL-6, IL-8, TNF-α, G-CSF, s-Fas, FGF, and nitrogen oxide were measured by capture ELISA. Results. Inhaled nitrogen oxide as a part of intensive care decreased the rate of sepsis development, the duration of mechanical ventilation, and the period of hospitalization. It provided a tendency towards a decrease in the rate of lethal outcomes and reduced cytokine aggression. Conclusions. Inhaled nitrogen oxide in standard intensive care effectively and safely prevented the development of sepsis in newborns with respiratory pathology on artificial lung ventilation. A decrease in the concentration of pro-inflammatory cytokines, including IL-6, against the background of nitrogen oxide inhalation, confirmed the possibility of using inhaled nitrogen oxide as a therapy for COVID-19.
Highlights
IntroductionA constant increase in the rate of development and a high lethality make sepsis remain one of the most fundamental problems of medicine and humanity, in general [1].The lowest tolerance to the development of bacterial complications is observed in newborns on artificial pulmonary ventilation, which is determined by a number of such factors as the severity of the condition due to the primary or comorbid diseases, the peculiarities of the functioning of the immune system, the necessity of the invasive methods of diagnostics and laboratory monitoring, the changes in the etiological structure of the infective microorganisms with the appearance of strains multi-resistant to the majority of antibiotics used in clinical practice [1, 2].These conditions indicate the necessity of the development of new methods of prevention and intensive therapy for bacterial complications because of a high rate of lethality in neonates with sepsis shows that conventional treatment plans are insufficient.Inhaled nitrogen oxide (iNO) occupies a certain place in the therapy for respiratory pathology of newborns considering the uniqueness of its activity, effectiveness, and safety confirmed by numerous studies [3,4,5,6,7,8,9].Nitrogen oxide (NO) is a universal intercellular messenger that is involved in the processes of proliferation, apoptosis of lymphocytes and monocytes, phagocytosis, and the activation of the complement system
The lowest tolerance to the development of bacterial complications is observed in newborns on artificial pulmonary ventilation, which is determined by a number of such factors as the severity of the condition due to the primary or comorbid diseases, the peculiarities of the functioning of the immune system, the necessity of the invasive methods of diagnostics and laboratory monitoring, the changes in the etiological structure of the infective microorganisms with the appearance of strains multi-resistant to the majority of antibiotics used in clinical practice [1, 2]
Inhaled nitrogen oxide occupies a certain place in the therapy for respiratory pathology of newborns considering the uniqueness of its activity, effectiveness, and safety confirmed by numerous studies [3,4,5,6,7,8,9]
Summary
A constant increase in the rate of development and a high lethality make sepsis remain one of the most fundamental problems of medicine and humanity, in general [1].The lowest tolerance to the development of bacterial complications is observed in newborns on artificial pulmonary ventilation, which is determined by a number of such factors as the severity of the condition due to the primary or comorbid diseases, the peculiarities of the functioning of the immune system, the necessity of the invasive methods of diagnostics and laboratory monitoring, the changes in the etiological structure of the infective microorganisms with the appearance of strains multi-resistant to the majority of antibiotics used in clinical practice [1, 2].These conditions indicate the necessity of the development of new methods of prevention and intensive therapy for bacterial complications because of a high rate of lethality in neonates with sepsis shows that conventional treatment plans are insufficient.Inhaled nitrogen oxide (iNO) occupies a certain place in the therapy for respiratory pathology of newborns considering the uniqueness of its activity, effectiveness, and safety confirmed by numerous studies [3,4,5,6,7,8,9].Nitrogen oxide (NO) is a universal intercellular messenger that is involved in the processes of proliferation, apoptosis of lymphocytes and monocytes, phagocytosis, and the activation of the complement system. The lowest tolerance to the development of bacterial complications is observed in newborns on artificial pulmonary ventilation, which is determined by a number of such factors as the severity of the condition due to the primary or comorbid diseases, the peculiarities of the functioning of the immune system, the necessity of the invasive methods of diagnostics and laboratory monitoring, the changes in the etiological structure of the infective microorganisms with the appearance of strains multi-resistant to the majority of antibiotics used in clinical practice [1, 2] These conditions indicate the necessity of the development of new methods of prevention and intensive therapy for bacterial complications because of a high rate of lethality in neonates with sepsis shows that conventional treatment plans are insufficient. A molecule of nitrogen oxide is multifunctional because it takes part in the intercellular and intracellular signaling by changing the cytokine milieu of the immunocompetent cells [10, 11]
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