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Evaluation of Inhaled Nitric Oxide Use in Patients with Pediatric Acute Respiratory Distress Syndrome [Behcet Uz Cocuk Hast Derg]
Behcet Uz Cocuk Hast Derg. 2021; 11(1): 94-100 | DOI: 10.5222/buchd.2021.46503  

Evaluation of Inhaled Nitric Oxide Use in Patients with Pediatric Acute Respiratory Distress Syndrome

Gülhan Atakul, Gokhan Ceylan, Ferhat Sarı, Özlem Sarac Sandal, Sevgi Topal, Mustafa Çolak, Utku Karaarslan, Hasan Agin
Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir

Objective: Nitric oxide therapy is not routinely used in the treatment of pediatric acute respiratory distress syndrome (PARDS), but it is recommended to be used as an adjunctive therapy in some selected cases. In our study, we aimed to discuss patients with PARDS who were treated with inhaled nitric oxide (iNO) therapy.
Methods: The data of patients who were hospitalized in the pediatric intensive care unit with a diagnosis of PARDS and received iNO treatment between January 2016 and January 2018 were retrospectively analyzed. Age, gender, length of stay, mortality, number of days on mechanical ventilation, use of vasoactive drugs, mortality scores, lactate levels, OI (oxygenation index), PaO2/FiO2, methemoglobin levels, iNO administration time, echocardiographic findings and underlying primary diseases were recorded.
Results: It was determined that 9 patients who were followed up with the diagnosis of PARDS were given iNO treatment. Except for one patient, they were diagnosed with pneumonia developing on the basis of chronic disease and PARDS secondary to septic shock. Five patients died while receiving iNO therapy. Seven patients were ventilated with iNO in addition to conventional mechanical ventilation methods. Two patients who died were ventilated with HFOV (high frequency oscillatory ventilation). In 3 of 9 patients, inhaled nitric oxide treatment was successful.
Conclusion: Although inhaled nitric oxide treatment is a known treatment used in different diseases, the level of its effect in PARDS patients continues to be investigated. We think that this treatment can be beneficial when applied in selected patients and experienced centers.

Keywords: pediatric acute respiratory distress syndrome, inhale nitric oxide, pediatric intensive care unit


Pediatrik Akut Respiratuar Distres Sendromu Tanılı Hastalarda İnhale Nitrik Oksit Kullanımının Değerlendirilmesi

Gülhan Atakul, Gokhan Ceylan, Ferhat Sarı, Özlem Sarac Sandal, Sevgi Topal, Mustafa Çolak, Utku Karaarslan, Hasan Agin
S.B.Ü Dr. Behçet Uz Çocuk Hastalıkları ve Çocuk Cerrahisi E.A.H

Amaç: İnhale nitrik oksit (iNO) tedavisi, pediatrik akut respiratuar distres sendromu (PARDS) tedavisinde rutin kullanılmamakla beraber bazı seçilmiş vakalarda ek tedavi yöntemi olarak kullanılması önerilen bir tedavidir. Çalışmamızda inhale nitrik oksit tedavisi alan PARDS tanılı hastaları tartışmayı amaçladık.
Yöntem: Ocak 2016 - Ocak 2018 tarihleri arasında çocuk yoğun bakım ünitesinde yatan PARDS tanısı İNO tedavisi alan ve alan hastaların dosyaları geriye dönük olarak incelendi. Yaş, cinsiyet, kalış süresi, mortalite, mekanik ventilasyonda geçen gün sayısı, vazoaktif ilaç kullanımı, mortalite skorları, laktat seviyeleri, OI (oksijenasyon indeksi), PaO2/FiO2 oranı, methemoglobin düzeyleri, iNO uygulama süresi, ekokardiyografik bulgular ve altta yatan birincil hastalıklar kaydedildi.
Bulgular: PARDS tanısıyla izlenen 9 hastaya iNO tedavisi uygulandığı saptandı. Bir hasta hariç diğerleri kronik hastalık zemininde gelişen pnömoni ve septik şoka sekonder PARDS tanısı almışlardı. Beş hasta, iNO tedavisi alırken eksitus gelişti. Yedi hasta konvansiyonel mekanik ventilasyon yöntemlerine ek olarak iNO ile solutuldu. Eksitus olan 2 hasta HFOV (high frequency oscillatory ventilation) ile solutuldu. 9 hastanın 3’ünde inhale nitrik oksit tedavisi başarılı olmuştu.
Sonuç: İnhale nitrik oksit tedavisi farklı hastalıklarda kullanılan bilinen bir tedavi olmasına rağmen, PARDS hastalarındaki etki düzeyi araştırılmaya devam etmektedir. Seçilmiş hastalarda ve deneyimli merkezlerde uygulandığında bu tedavinin faydalı olabileceğini düşünüyoruz.

Anahtar Kelimeler: pediatrik akut respiratuar distres sendromu, inhale nitrik oksit, pediatrik yoğun bakım ünitesi


Gülhan Atakul, Gokhan Ceylan, Ferhat Sarı, Özlem Sarac Sandal, Sevgi Topal, Mustafa Çolak, Utku Karaarslan, Hasan Agin. Evaluation of Inhaled Nitric Oxide Use in Patients with Pediatric Acute Respiratory Distress Syndrome. Behcet Uz Cocuk Hast Derg. 2021; 11(1): 94-100

Corresponding Author: Gülhan Atakul, Türkiye


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