Akuter Effekt von inhalativem Stickstoffmonoxid auf die Oxygenation bei Kindern mit Virus-induzierter, hypoxämischer Ateminsuffizienz

Background: Inhaled nitric oxide (iNO) has been used to improve oxygenation in adults and children with acute respiratory distress syndrome (ARDS) since several years. Previous studies on the effect of iNO in patients with ARDS were usually lumped together with respect to causation. Methods: We describe the acute effect of iNO in 4 children (age 4–54 months) suffering from acute, virus-induced, hypoxemic respiratory failure. Inhaled NO was administered at a dose of 20 ppm during the first hour and subsequently decreased to a dose of 5 ppm. The effects on oxygenation were assessed by changes in arterial oxygen tension and in the oxygenation index at one and 4 hours after initiating iNO therapy. Results: Inhaled NO dramatically improved oxygenation in 3 of 4 children and reduced the oxygenation index by more than 30%. One patient showed no improvement in oxygenation, but a significant reduction in pulmonary vascular resistance. Discussion: Although previous studies have failed to show any benefit of iNO on the survival rate of children with ARDS, we believe that its use can be justified if the improvement in oxygenation helps to stabilise the patient during the acute stage of hypoxemic respiratory failure.