The use of inhaled nitric oxide as adjuvant therapy in patients with burn injuries and respiratory failure.

Abstract

Inhaled nitric oxide (NO) is a relatively new modality in the management of acute respiratory distress syndrome. The purpose of this study was to examine our experience with inhaled NO in 10 adult patients with burn injuries and acute respiratory distress syndrome-related oxygenation failure. The patients had a mean age of 50 +/- 19 years and a mean burn size of 41% +/- 20% of the total body surface area. Seven patients died and 3 survived. The survivors and nonsurvivors did not differ with respect to age, burn size, pre-NO ventilator settings, or indices of oxygenation including PaO2, oxygen saturation in arterial blood, PaO2/fraction of inspired oxygen (FIO2) ratio, and alveolar-arterial oxygen tension difference. The concentration of NO administered ranged between 5 ppm and 30 ppm. PaO2, oxygen saturation in arterial blood, and the PaO2/FIO2 ratio increased in all patients. Although it was not statistically significant, survivors tended to have a more vigorous and sustained response than non-survivors; this was best exemplified by the change in PFR. During the first hour of therapy, the PaO2/FIO2 ratio increased from 64.3 +/- 12.7 to 231.8 +/- 154.5 in survivors and from 93.9 +/- 44.0 to 161.5 +/- 81.8 in the nonsurvivors. After 12 hours of therapy, the PaO2/FIO2 ratio was 306.2 +/- 333.7 in the survivors and 178.9 +/- 69.9 in the nonsurvivors. There were no complications associated with the use of inhaled NO. Although a stronger early response to NO seems to occur in survivors, we cannot definitely conclude that the early response pattern is predictive of recovery. Nonetheless, we believe that inhaled NO has a useful role in the treatment of patients with burn injuries and severe acute respiratory distress syndrome-related oxygenation failure.