Evaluating the Validity of Responsiveness to Inhaled Nitric Oxide in Pediatric Patients With ARDS

Baldauf, Mary; Silver, Peter; Sagy, Mayer

doi:10.1378/chest.119.4.1166

Cited by 6 publications

(2 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In older children and adults with AHRF, iNO improves PaO 2 and reduces pulmonary artery pressure in the acute phase of its application, if only temporarily [62,107,[114][115][116]. However, it is not a part of standard therapy in this population because clinical reports suggest that it does not increase survival rates or the number of ventilator-free days, nor does it reduce the need for ECMO [117].…”

Section: Inhaled Vasodilatorsmentioning

confidence: 99%

“…As multiple therapies are simultaneously instituted in a critically ill patient with AHRF, it is difficult to evaluate the efficacy of iNO alone. Baldauf et al [114] evaluated 119 data points in 19 ARDS patients during the first 72 hours of iNO therapy. They found that in 42% of these data points, improvement in oxygenation was not due to iNO alone.…”

Section: Inhaled Vasodilatorsmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Acute Hypoxemic Respiratory Failure: Management of Oxygenation

Prodhan

Noviski

2004

J Intensive Care Med

View full text Add to dashboard Cite

Acute hypoxemic respiratory failure (AHRF) is one of the hallmarks of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), which are caused by an inflammatory process initiated by any of a number of potential systemic and/or pulmonary insults that result in heterogeneous disruption of the capillary-pithelial interface. In these critically sick patients, optimizing the management of oxygenation is crucial. Physicians managing pediatric patients with ALI or ARDS are faced with a complex array of options influencing oxygenation. Certain treatment strategies can influence clinical outcomes, such as a lung protective ventilation strategy that specifies a low tidal volume (6 mL/kg) and a plateau pressure limit (30 cm H(2)O). Other strategies such as different levels of positive end expiratory pressure, altered inspiration to expiration time ratios, recruitment maneuvers, prone positioning, and extraneous gases or drugs may also affect clinical outcomes. This article reviews state-of-the-art strategies on the management of oxygenation in acute hypoxemic respiratory failure in children.

show abstract

Section: Inhaled Vasodilatorsmentioning

confidence: 99%

Section: Inhaled Vasodilatorsmentioning

confidence: 99%

Pediatric Acute Hypoxemic Respiratory Failure: Management of Oxygenation

Prodhan

Noviski

2004

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

Acute lung injury and acute respiratory distress syndrome

2004

View full text Add to dashboard Cite

Acute lung injury and acute respiratory distress syndrome are an important challenge for pediatric intensive care units. These disorders are characterized by a significant inflammatory response to a local (pulmonary) or remote (systemic) insult resulting in injury to alveolar epithelial and endothelial barriers of the lung, acute inflammation and protein rich pulmonary edema. The reported rates in children vary from 8.5 to 16 cases / 1000 pediatric intensive care unit (PICU) admissions. The pathological features of ARDS are described as passing through three overlapping phases - an inflammatory or exudative phase (0-7 days), a proliferative phase (7-21 days) and lastly a fibrotic phase (from day 10). The treatment of ARDS rests on good supportive care and control of initiating cause. The goal of ventilating patients with ALI/ARDS should be to maintain adequate gas exchange with minimal ventilator induced lung injury. This can be achieved by use of optimum PEEP, low tidal volume and appropriate FiO2. High frequency ventilation can improve oxygenation but does affect the outcomes. Prone positioning is a useful strategy to improve oxygenation. Pharmacological strategies have not made any significant impact on the outcomes. Preliminary data suggests some role for use of corticosteroids in non-resolving ARDS. The mortality rates have declined over the last decade chiefly due to the advances in supporting critically ill patients.

show abstract