Early Response to Inhaled Nitric Oxide and Its Relationship to Outcome in Children With Severe Hypoxemic Respiratory Failure
To examine whether the early response to inhaled nitric oxide (iNO) is a measure of reversibility of lung injury and patient outcome in children with acute hypoxemic respiratory failure (AHRF). Retrospective review study. Pediatric ICUs. Thirty infants and children, aged 1 month to 13 years (median,...
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| Veröffentlicht in: | Chest 1997-09, Vol.112 (3), p.752-758 |
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| creator | Goldman, Allan P. Tasker, Robert C. Hosiasson, Stephan Henrichsen, Thore Macrae, Duncan J. |
| description | To examine whether the early response to inhaled nitric oxide (iNO) is a measure of reversibility of lung injury and patient outcome in children with acute hypoxemic respiratory failure (AHRF).
Retrospective review study.
Pediatric ICUs.
Thirty infants and children, aged 1 month to 13 years (median, 7 months) with severe AHRF (mean alveolar arterial oxygen gradient of 568 ±9.3 mm Hg, PaO2/fraction of inspired oxygen of 56±2.3, oxygenation index [OI] of 41±3.8, and acute lung injury score of 2.8±0.1). Eighteen patients had ARDS.
The magnitude of the early response to iNO was quantified as the percentage change in OI occurring within 60 min of initiating 20 ppm iNO therapy. This response was compared to patient outcome data.
There was a significant association between early response to iNO and patient outcome (Kendall tau R r=0.43, p |
| doi_str_mv | 10.1378/chest.112.3.752 |
| format | Article |
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Retrospective review study.
Pediatric ICUs.
Thirty infants and children, aged 1 month to 13 years (median, 7 months) with severe AHRF (mean alveolar arterial oxygen gradient of 568 ±9.3 mm Hg, PaO2/fraction of inspired oxygen of 56±2.3, oxygenation index [OI] of 41±3.8, and acute lung injury score of 2.8±0.1). Eighteen patients had ARDS.
The magnitude of the early response to iNO was quantified as the percentage change in OI occurring within 60 min of initiating 20 ppm iNO therapy. This response was compared to patient outcome data.
There was a significant association between early response to iNO and patient outcome (Kendall tau R r=0.43, p<0.02). All six patients who showed <15% improvement in OI died; 4 of the 11 patients (36%) who had a 15 to 30% improvement in OI survived, while 8 of 13 (61%) who had a >30% improvement in OI survived. Overall, 12 patients (40%) survived, 9 with ongoing conventional treatment including iNO, and 3 with extracorporeal support.
In AHRF in children, greater early response to iNO appears to be associated with improved outcome. This may reflect reversibility of pulmonary pathophysiologic condition and serve as a bedside marker of disease stage.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.112.3.752</identifier><identifier>PMID: 9315811</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Acute Disease ; acute hypoxemic respiratory failure ; acute respiratory distress syndrome ; Administration, Inhalation ; Adolescent ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Clinical outcomes ; Critical Care ; Disease ; Emergency and intensive respiratory care ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Hypoxia - drug therapy ; Hypoxia - physiopathology ; Infant ; inhaled nitric oxide ; Intensive care medicine ; Lung - drug effects ; Lung - physiopathology ; Male ; Medical sciences ; Nitric oxide ; Nitric Oxide - administration & dosage ; Nitric Oxide - therapeutic use ; Oxygen - blood ; Oxygen Consumption - drug effects ; Patients ; Pulmonary Fibrosis - physiopathology ; Pulmonary Gas Exchange - drug effects ; Pulmonary hypertension ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult - drug therapy ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory failure ; Respiratory Insufficiency - drug therapy ; Respiratory Insufficiency - physiopathology ; Respiratory System Agents - administration & dosage ; Respiratory System Agents - therapeutic use ; Retrospective Studies ; Surfactants ; Survival Rate ; Time Factors ; Treatment Outcome ; Ventilation</subject><ispartof>Chest, 1997-09, Vol.112 (3), p.752-758</ispartof><rights>1997 The American College of Chest Physicians</rights><rights>1997 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Sep 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-52206c78b2bbea0815bea94cc6ca8b14b34c157857f6fe698ae494641b745a83</citedby><cites>FETCH-LOGICAL-c467t-52206c78b2bbea0815bea94cc6ca8b14b34c157857f6fe698ae494641b745a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2826639$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9315811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goldman, Allan P.</creatorcontrib><creatorcontrib>Tasker, Robert C.</creatorcontrib><creatorcontrib>Hosiasson, Stephan</creatorcontrib><creatorcontrib>Henrichsen, Thore</creatorcontrib><creatorcontrib>Macrae, Duncan J.</creatorcontrib><title>Early Response to Inhaled Nitric Oxide and Its Relationship to Outcome in Children With Severe Hypoxemic Respiratory Failure</title><title>Chest</title><addtitle>Chest</addtitle><description>To examine whether the early response to inhaled nitric oxide (iNO) is a measure of reversibility of lung injury and patient outcome in children with acute hypoxemic respiratory failure (AHRF).
Retrospective review study.
Pediatric ICUs.
Thirty infants and children, aged 1 month to 13 years (median, 7 months) with severe AHRF (mean alveolar arterial oxygen gradient of 568 ±9.3 mm Hg, PaO2/fraction of inspired oxygen of 56±2.3, oxygenation index [OI] of 41±3.8, and acute lung injury score of 2.8±0.1). Eighteen patients had ARDS.
The magnitude of the early response to iNO was quantified as the percentage change in OI occurring within 60 min of initiating 20 ppm iNO therapy. This response was compared to patient outcome data.
There was a significant association between early response to iNO and patient outcome (Kendall tau R r=0.43, p<0.02). All six patients who showed <15% improvement in OI died; 4 of the 11 patients (36%) who had a 15 to 30% improvement in OI survived, while 8 of 13 (61%) who had a >30% improvement in OI survived. Overall, 12 patients (40%) survived, 9 with ongoing conventional treatment including iNO, and 3 with extracorporeal support.
In AHRF in children, greater early response to iNO appears to be associated with improved outcome. This may reflect reversibility of pulmonary pathophysiologic condition and serve as a bedside marker of disease stage.</description><subject>Acute Disease</subject><subject>acute hypoxemic respiratory failure</subject><subject>acute respiratory distress syndrome</subject><subject>Administration, Inhalation</subject><subject>Adolescent</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical outcomes</subject><subject>Critical Care</subject><subject>Disease</subject><subject>Emergency and intensive respiratory care</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoxia - drug therapy</subject><subject>Hypoxia - physiopathology</subject><subject>Infant</subject><subject>inhaled nitric oxide</subject><subject>Intensive care medicine</subject><subject>Lung - drug effects</subject><subject>Lung - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nitric oxide</subject><subject>Nitric Oxide - administration & dosage</subject><subject>Nitric Oxide - therapeutic use</subject><subject>Oxygen - blood</subject><subject>Oxygen Consumption - drug effects</subject><subject>Patients</subject><subject>Pulmonary Fibrosis - physiopathology</subject><subject>Pulmonary Gas Exchange - drug effects</subject><subject>Pulmonary hypertension</subject><subject>Respiration, Artificial</subject><subject>Respiratory Distress Syndrome, Adult - drug therapy</subject><subject>Respiratory Distress Syndrome, Adult - physiopathology</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - drug therapy</subject><subject>Respiratory Insufficiency - physiopathology</subject><subject>Respiratory System Agents - administration & dosage</subject><subject>Respiratory System Agents - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Surfactants</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kd-L1DAQx4so53r67JMQRHzrXn41TR9lufMWDhf0wMeQplObI23WJD1vwT_erFtOEXwahvnM9zvMtyheE7wmrJYXZoCY1oTQNVvXFX1SrEjDSMkqzp4WK4wJLZlo6PPiRYx3OPekEWfFWWYqSciq-HmpgzugzxD3foqAkkfbadAOOvTJpmAN2j3YDpCeOrRNMYNOJ5vRwe6P8G5Oxo-A7IQ2g3VdgAl9tWlAX-AeAqDrw94_wJh1jhY26OTDAV1p6-YAL4tnvXYRXi31vLi9urzdXJc3u4_bzYeb0nBRp7KiFAtTy5a2LWgsSZVLw40RRsuW8JZxQ6paVnUvehCN1MAbLjhpa15pyc6L9yfZffDf5_wvNdpowDk9gZ-jqvM3CJZVBt_-A975OUz5NEUx5hWrMc3QxQkywccYoFf7YEcdDopgdcxE_c5E5UwUUzmTvPFmkZ3bEbpHfgkhz98tcx2Ndn3Qk7HxEaOSCsGaP8aD_Tb8sAFUHLVzWZSdLJdj_zZuThuQn3tvIahoLEwGurxtkuq8_e_RvwASxro1</recordid><startdate>19970901</startdate><enddate>19970901</enddate><creator>Goldman, Allan P.</creator><creator>Tasker, Robert C.</creator><creator>Hosiasson, Stephan</creator><creator>Henrichsen, Thore</creator><creator>Macrae, Duncan J.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>19970901</creationdate><title>Early Response to Inhaled Nitric Oxide and Its Relationship to Outcome in Children With Severe Hypoxemic Respiratory Failure</title><author>Goldman, Allan P. ; Tasker, Robert C. ; Hosiasson, Stephan ; Henrichsen, Thore ; Macrae, Duncan J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-52206c78b2bbea0815bea94cc6ca8b14b34c157857f6fe698ae494641b745a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Acute Disease</topic><topic>acute hypoxemic respiratory failure</topic><topic>acute respiratory distress syndrome</topic><topic>Administration, Inhalation</topic><topic>Adolescent</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical outcomes</topic><topic>Critical Care</topic><topic>Disease</topic><topic>Emergency and intensive respiratory care</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoxia - drug therapy</topic><topic>Hypoxia - physiopathology</topic><topic>Infant</topic><topic>inhaled nitric oxide</topic><topic>Intensive care medicine</topic><topic>Lung - drug effects</topic><topic>Lung - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nitric oxide</topic><topic>Nitric Oxide - administration & dosage</topic><topic>Nitric Oxide - therapeutic use</topic><topic>Oxygen - blood</topic><topic>Oxygen Consumption - drug effects</topic><topic>Patients</topic><topic>Pulmonary Fibrosis - physiopathology</topic><topic>Pulmonary Gas Exchange - drug effects</topic><topic>Pulmonary hypertension</topic><topic>Respiration, Artificial</topic><topic>Respiratory Distress Syndrome, Adult - drug therapy</topic><topic>Respiratory Distress Syndrome, Adult - physiopathology</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - drug therapy</topic><topic>Respiratory Insufficiency - physiopathology</topic><topic>Respiratory System Agents - administration & dosage</topic><topic>Respiratory System Agents - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Surfactants</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goldman, Allan P.</creatorcontrib><creatorcontrib>Tasker, Robert C.</creatorcontrib><creatorcontrib>Hosiasson, Stephan</creatorcontrib><creatorcontrib>Henrichsen, Thore</creatorcontrib><creatorcontrib>Macrae, Duncan J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goldman, Allan P.</au><au>Tasker, Robert C.</au><au>Hosiasson, Stephan</au><au>Henrichsen, Thore</au><au>Macrae, Duncan J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Response to Inhaled Nitric Oxide and Its Relationship to Outcome in Children With Severe Hypoxemic Respiratory Failure</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1997-09-01</date><risdate>1997</risdate><volume>112</volume><issue>3</issue><spage>752</spage><epage>758</epage><pages>752-758</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>To examine whether the early response to inhaled nitric oxide (iNO) is a measure of reversibility of lung injury and patient outcome in children with acute hypoxemic respiratory failure (AHRF).
Retrospective review study.
Pediatric ICUs.
Thirty infants and children, aged 1 month to 13 years (median, 7 months) with severe AHRF (mean alveolar arterial oxygen gradient of 568 ±9.3 mm Hg, PaO2/fraction of inspired oxygen of 56±2.3, oxygenation index [OI] of 41±3.8, and acute lung injury score of 2.8±0.1). Eighteen patients had ARDS.
The magnitude of the early response to iNO was quantified as the percentage change in OI occurring within 60 min of initiating 20 ppm iNO therapy. This response was compared to patient outcome data.
There was a significant association between early response to iNO and patient outcome (Kendall tau R r=0.43, p<0.02). All six patients who showed <15% improvement in OI died; 4 of the 11 patients (36%) who had a 15 to 30% improvement in OI survived, while 8 of 13 (61%) who had a >30% improvement in OI survived. Overall, 12 patients (40%) survived, 9 with ongoing conventional treatment including iNO, and 3 with extracorporeal support.
In AHRF in children, greater early response to iNO appears to be associated with improved outcome. This may reflect reversibility of pulmonary pathophysiologic condition and serve as a bedside marker of disease stage.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>9315811</pmid><doi>10.1378/chest.112.3.752</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute Disease acute hypoxemic respiratory failure acute respiratory distress syndrome Administration, Inhalation Adolescent Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Child Child, Preschool Clinical outcomes Critical Care Disease Emergency and intensive respiratory care Extracorporeal Membrane Oxygenation Female Humans Hypoxia - drug therapy Hypoxia - physiopathology Infant inhaled nitric oxide Intensive care medicine Lung - drug effects Lung - physiopathology Male Medical sciences Nitric oxide Nitric Oxide - administration & dosage Nitric Oxide - therapeutic use Oxygen - blood Oxygen Consumption - drug effects Patients Pulmonary Fibrosis - physiopathology Pulmonary Gas Exchange - drug effects Pulmonary hypertension Respiration, Artificial Respiratory Distress Syndrome, Adult - drug therapy Respiratory Distress Syndrome, Adult - physiopathology Respiratory failure Respiratory Insufficiency - drug therapy Respiratory Insufficiency - physiopathology Respiratory System Agents - administration & dosage Respiratory System Agents - therapeutic use Retrospective Studies Surfactants Survival Rate Time Factors Treatment Outcome Ventilation |
| title | Early Response to Inhaled Nitric Oxide and Its Relationship to Outcome in Children With Severe Hypoxemic Respiratory Failure |
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