REGIONAL DISTRIBUTION OF NITRIC OXIDE (NO) and NITRIC DIOXIDE (NO2) DURING INHALATIONAL THERAPY: EFFECT OF VENTILATION STRATEGY. † 2329

Taulane, Joan; Robinson, Nancy M.; Ginda, Maureen; Shaffer, Thomas H.; Billmire, Deborah F.; Wolfson, Marla R.

doi:10.1203/00006450-199604001-02354

Cited by 6 publications

(4 citation statements)

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“…In addition, the clearance of NO from the PFC liquid-filled lung and potential formation of NO 2 during liquid ventilation may also be very different as compared to the gas-filled lung. 78 LAV studies to date indicate that PFC liquid may be a useful vehicle for delivering therapeutic levels of other agents (i.e., bronchodilators, exogenous surfactant, antibiotics, steroids, chemotherapeutics, mucolytics, antioxidants, and gene therapy products) directly to the lung, while protecting nontargeted organs from iatrogenic effects. In addition, the methodology may serve as a diagnostic tool.…”

mentioning

confidence: 99%

Liquid-assisted ventilation: An alternative respiratory modality

1998

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mentioning

confidence: 99%

Liquid-assisted ventilation: An alternative respiratory modality

1998

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“…Response or nonresponse to iNO might be directly related to the degree of lung expansion [25], which can be variable during the course of the underlying disease. The clinical response to iNO seems to depend on the choice of the ventilatory strategy applied, since the regional distribution of NO and NO 2 changes with different modes of ventilation (conventional ventilation/HFV) [26]. Since optimal lung expansion appears to be crucial for iNO in order to reach substantial parts of the lung, mean airway pressure was increased during radiologic monitoring ( fig.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Respiratory Failure with Inhaled Nitric Oxide and High- Frequency Ventilation in an Infant with Respiratory Syncytial Virus Pneumonia and Bronchopulmonary Dysplasia

Hoehn¹,

Krause²,

Krueger³

et al. 1998

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In a 7-month-old infant with bronchopulmonary dysplasia and respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency ventilation (HFV) and inhaled nitric oxide (iNO) in terms of improved oxygenation and the avoidance of extracorporeal membrane oxygenation. Apparently, the combined therapy of HFV and iNO is superior to either therapeutic modality alone in the treatment of hypoxemic respiratory failure due to RSV pneumonia. The mechanism of increased lung expansion and alveolar recruitment appears to be responsible for a favorable clinical outcome. We conclude that the combined therapy of HFV and iNO should be considered in hypoxemic respiratory failure in pediatric patients.

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“…Response or nonresponse might be directly related to the degree of lung expansion [23], which can be inconsistent during the course of the underlying disease. The clinical response to iNO might also depend on the choice of the ventilatory strategy, since the regional distribution of NO changes with different modes of ventilation (CMV/ HFOV/high-frequency jet ventilation) [24].…”

Section: Discussionmentioning

confidence: 99%

High-frequency ventilation augments the effect of inhaled nitric oxide in persistent pulmonary hypertension of the newborn

Hoehn¹,

Krause²,

Hentschel³

1998

Eur Respir J

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aaHigh-frequency ventilation (HFV) is widely used for rescue treatment of hypoxaemic neonates and premature infants [1]. Although its role as a first-line mode of ventilation has not been established, it is often applied in newborns with respiratory failure, who cannot be successfully managed with conventional mechanical ventilation (CMV). The results of recent studies investigating the theoretically diminished baro-and volutrauma remain equivocal. Nonetheless there is evidence for a decreased secretion of inflammatory mediators [2] and a reduced amount of lung oedema [3] using high-frequency oscillatory ventilation (HFOV) with or without additional application of exogenous surfactant.Inhaled nitric oxide (iNO) as a treatment for neonatal pulmonary hypertension has been in use for the past few years, both in premature infants and in term neonates [4][5][6][7][8][9]. It is worth noting that the first published application of iNO in a premature infant, and the subsequent improvement of oxygenation, occurred during HFOV [10]. Although still an experimental treatment, NO inhalation plays an important therapeutic role in severe hypoxaemia of the newborn due mainly to extrapulmonary shunting [11,12].Recently, a randomized, multicentre trial showed that the combination of iNO and HFOV was superior in term neonates, as compared to either treatment alone [13]. We report a similar experience in a full-term neonate, but also in a premature infant of 29 weeks of gestation. Case 1The term infant was delivered by caesarean section because of maternal hypertension. There was no maternal history of infection. The infant was male and had a birth weight of 3,810 g and Apgar 9,10,10 (1',5',10'); he became symptomatic at the age of 15 min with intercostal retractions and grunting. At that stage, capillary blood gases were: pH 7.23, capillary carbon dioxide tension (Pc,CO 2 ) 8.0 kPa (60 mmHg), capillary oxygen tension (Pc,O 2 ) 4.0 kPa (30 mmHg) in combination with an increasing inspiratory oxygen fraction (FI,O 2 ). At the age of 2 h the neonatal transport team was called, which arrived about 1 h later. The infant was intubated and ventilated because of persistent cyanosis, antibiotic treatment was started and he was transferred to our neonatal intensive care unit. Upon arrival, bovine surfactant (100 mg·kg -1 ) was applied; in order to achieve adequate oxygenation, peak inspiratory pressures (PIPs) up to 4.6 kPa were required (positive endexpiratory pressure (PEEP) 0.5 kPa, rate 70 breaths·min -1 , inspiratory time 0.35 s, mean airway pressure (MAP) 1.8 kPa, FI,O 2 1.0). After approximately 6 h a sudden deterioration of oxygenation and arterial blood pressure occurred, caused by a pneumopericard, which was relieved by drainage. During this event, profound hypoxia occurred for about 15 min, the continuously recorded arterial oxygen saturation (Sa,O 2 ) (measured by pulsoximetry) was approximately 20%. Following drainage of the pneumopericard We report two cases of newborn infants with profound hypoxaemia, who did not respond with ...

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REGIONAL DISTRIBUTION OF NITRIC OXIDE (NO) and NITRIC DIOXIDE (NO2) DURING INHALATIONAL THERAPY: EFFECT OF VENTILATION STRATEGY. † 2329

Cited by 6 publications

References 0 publications

Liquid-assisted ventilation: An alternative respiratory modality

Liquid-assisted ventilation: An alternative respiratory modality

Treatment of Respiratory Failure with Inhaled Nitric Oxide and High- Frequency Ventilation in an Infant with Respiratory Syncytial Virus Pneumonia and Bronchopulmonary Dysplasia

High-frequency ventilation augments the effect of inhaled nitric oxide in persistent pulmonary hypertension of the newborn

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