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Rescue therapy with inhaled nitric oxide in critically ill patients with severe hypoxemic respiratory failure (Brief report)

[Thérapie de secours par l'inhalation d'oxyde nitrique chez de grands malades atteints d'insuffisance respiratoire hypoxémique]

Fred J. Baxter, MD FRCPC^*,, Jill Randall, BA RRT RRCP, John D. Miller, MD FRCSC^¶, David A. Higgins, MB FRCPC, A.C. Peter Powles, MB CHB FRCPC^, and Peter T.-L. Choi, MD FRCPC MSc^*

^* From the Departments of Anaesthesia,
Medicine, and
Respiratory Therapy, and
the Divisions of Critical Care Medicine, and
^¶ Thoracic Surgery, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada.

Dr. Fred Baxter, Department of Anaesthesia, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. Phone: 905-522-4941 (ext. 3853); Fax: 905-521-6019; E-mail: barbroszel{at}hotmail.com

Purpose: To evaluate the efficacy of inhaled nitric oxide (iNO) on oxygenation, shunt, and pulmonary vascular resistance index (PVRI) in severely hypoxemic, ventilated patients.

Methods: In a two-period double-blind crossover design, 14 critically ill, hypoxemic, ventilated patients were randomized to receive iNO 10 ppm in 100% oxygen or no iNO in 100% oxygen for 30 min followed by a 30-min washout period and then crossed over to the other intervention. Responders to iNO then received iNO, which was increased from 5 ppm to 25 ppm in 5 ppm increments. Severity of illness scores and cardiorespiratory variables were measured.

Results: Nitric oxide decreased shunt (P=0.002) and PVRI (P=0.033) and increased oxygenation (P=0.011) although the latter two were not statistically significant after adjustment for multiple comparisons. Treatment by period interactions were observed.

Conclusion: Our findings suggest that iNO improves oxygenation to a clinically significant extent in critically ill patients who are severely hypoxemic.