Low-dose inhaled nitric oxide in acutely burned children with profound respiratory failure

Abstract

Inhaled nitric oxide (NO) is a rapidly acting selective pulmonary vasodilator that partially reverses the pathophysiology of acute respiratory distress syndrome (ARDS). After human studies approval, we studied 11 burned children with severe ARDS in a trial of inhaled NO therapy, assessing its effect on intrapulmonary shunt as measured by the PaO2/FiO2 ratio (PFR). There were 12 episodes of administration; 1 child was treated twice. The children had an average age of 8.3 +/- 4.8 years (mean +/- SEM, range 11 months to 14 years) and average burn size of 64% +/- 22%. At the time of enrollment, the PFR averaged 95 +/- 50 and Murray lung score 3.1 +/- 0.5. Inhaled NO was begun an average of 6.3 +/- 5.5 days after injury and was administered for an average of 7.8 +/- 7.2 days at an average dose of 6.7 +/- 2.4 parts per million. PFR improved an average of 162% +/- 214%. Eight of the 11 children (73%) survived. The 3 nonsurvivors had similar admission PFR values (100 +/- 75 versus 93 +/- 44, P = .089) but a significantly less favorable initial response to inhaled NO, with a percentage of improvement in PFR at 1 hour after enrollment of 7.3% +/- 6.4% versus 213% +/- 226% (P = .026). There were no complications related to NO administration. Inhaled NO can be safely administered to treat ARDS in children with acute burns and appears to improve their ventilatory management. An immediate improvement in PFR with inhaled NO may correlate with survival.