The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

INHALED NITRIC OXIDE THERAPY FOR TREATMENT OF SEVERE BRONCHOPULMONARY DYSPLASIA: A CASE STUDY

Sandra R. Wadlinger, BA, RRT, CPFT, P/P Specialist, Lorraine P. Hough, Med, RRT, CPFT, Beverly A. Banks, MD, PhD, Roberta A. Ballard, MD, Department of Respiratory Care, The Children's Hospital of Philadelphia and The Hospital of the University of Pennsylvania, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA.

INTRODUCTION: Bronchopulmonary Dysplasia (BPD) continues to be a major source of morbidity and mortality in premature infants. Inhaled Nitric Oxide (NO) has been demonstrated to improve oxygenation in various disease states characterized by pulmonary hypertension and ventilation perfusion mismatch. This case report examines the use of inhaled Nitric Oxide to improve oxygenation in an infant with severe BPD.

CASE SUMMARY: The study infant was a 29 day old former 880 gram product of a 26 week gestation. His neonatal course was complicated by respiratory distress syndrome, systemic hypotension, patent ductus arteriosis, pulmonary hemorrhage, sepsis and pneumonia. His condition remained critical despite interventions including surfactant replacement, dopamine and epinephrine infusions, indocin therapy, antibiotic therapy, high frequency oscillatory ventilation and dexamethasone treatment. On day of life 29, after two weeks requiring 100% oxygen, he was given a trial of inhaled NO as a final effort to improve his respiratory status. At the initiation of NO therapy, his ventilator settings were a peak inspiratory pressure (PIP) of 35cmH_{2}O, positive end expiratory pressure (PEEP) of 8cmH_{2}O, ventilator rate of 40 breaths/minute, 100% oxygen with a mean airway pressure (MAP) of 18cmH_{2}O. Following one hour of inhaled NO, his PaO_{2} increased from 48 mmHg to 80 mmHg. After 24 hours of inhaled NO he successfully weaned to 70% oxygen. During the first week of therapy, the infant tolerated substantial reductions in his ventilatory requirement with a decrease in MAP from 18cmH_{2}O to 11cmH_{2}O. This progressive decrease in ventilatory support was sustained throughout the treatment period. Methemoglobin levels were obtained at regular intervals and never exceeded 0.2% (acceptable range 0.0-2.8). After 33 days, his ventilator settings were a PIP of 22cmH_{2}O, PEEP of 7cmH_{2}O, ventilator rate of 32 breaths/minute, 40% oxygen with a MAP of 11cmH_{2}O. NO therapy was discontinued at this time with no increase in ventilatory support required. The following chart summarizes oxygenation status:

Treatment Day NOppm PaO_{2}/FiO_{2} Oxygenation Index

0 0 48 37

1 20 73 22

3 20 121 12

11 10 297 4

31 3 175 6

33 0 161 6

CONCLUSION: Inhaled Nitric Oxide therapy seemed to be valuable in this patient with severe ventilator dependent Bronchopulmonary Dysplasia allowing him to tolerate lower inspired oxygen concentrations and decreased ventilator support.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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