The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

I - NO Therapy

Peter Betit, RRT, Sunday, December 7, 1997.

Acute respiratory syndrome (ARDS) in children continues to be associated with a mortality rate some where in the order of 50% to 70%. Similar to the adult experience, inhaled nitric oxide may be an important adjunct in the clinical management of pediatric ARDS. It has been demonstrated that inhaled nitric oxide reduces pulmonary vascular resistance and associated pulmonary edema, enhances the ventilation/perfusion relationship, and subsequently aids in minimizing oxygen and ventilation requirements.

Pulmonary hypertension can significantly complicate congenital heart disease. As a selective pulmonary vasodilator, inhaled nitric oxide improves the clinical management of pulmonary hypertension associated with congenital heart disease. Diagnostic applications aide in determining treatment strategies including surgical palliation versus repair, and therapeutic applications attenuate pulmonary hypertensive crises in the perioperative period.

Future applications of inhaled nitric oxide in pediatrics may include sickle cell diseases and asthma. The administration of inhaled nitric oxide to patients in sickle cell crisis may reduce pulmonary vascular and right ventricular afterload, redistribute pulmonary blood flow to well ventilated lung units, and reduce sickling by enhancing the sickle hemoglobin's affinity for oxygen.

The role that endogenous nitric oxide exerts during airway inflammation is becoming better understood. It has been demonstrated that exhaled nitric oxide levels are higher in patients with asthma. The therapeutic benefits of inhaled nitric oxide are less understood but are beginning to be investigated.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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