The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

NITRIC OXIDE AND SURFACTANT REPLACEMENT IN PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME: A CASE REVIEW.

Shawn Colborn, AS, RRT, Angela Mittman, AS, RRT, P/P Spec., Lorraine F. Hough, MEd, RRT, CPFT, P/P Spec., Margaret Priestly, MD, Theresa Ryan Schultz, BA, RRT, CPFT, P/P Spec., The Children's Hospital of Philadelphia, Philadelphia, PA.

Introduction: This is a 2 year old female whose past medical history includes tracheostomy, secondary to trachiobronchomalacia, and reactive airways disease with new onset bronchiolitis/respiratory failure. She was admitted to our Pediatric Intensive Care Unit from an outlying institution where she had been decannulated, intubated and mechanically ventilated for thirty-six hours. Persistent hypercarbia and hypoxemia with ground glass appearance on chest roentgenogram were reported. Upon arrival, her ventilatory requirement of 189 cc/kg/min. corrected exhaled minute ventilation, PEEP 15 cm H2O, PIP 37 cm H2O and FiO2 1.0 yielded the following: pH 7.28, PaCO2 67.5, PaO2 77.5, HCO3 36.3, B.E. 10.3, PaO2/FiO2 (P/F) 78, Oxygenation Index (OI) 30. A cuffed endotracheal tube was later placed, due to continued leakage around the uncuffed tube.

Methods: During this admission, a multitude of interventions were trialed including terbutaline, versed, fentanyl and pavulon infusions, solumedrol, zantac, lasix, inhaled nitric oxide (NO) and Survanta administration via direct instillation.

Results: This graph shows varied responses to inhaled nitric oxide pre and post Survanta delivery with no other changes in patient intervention.

Nitric oxide pre Survanta administration P/F % change OI % change
Admission (day 2 of mechanical ventilation-MV) 78 - 30 -
1 hr. into 1st NO trial (day 3 of MV) 72 No response 31 -
2 hrs. into 1st NO trial (day 3 of MV) 60 No response 37 -
6 hrs. into 1st NO trial 60 No response 35 -
(discontinued on day 3 of MV)
Survanta administration P/F % change OI % change
Pre surfactant administration (day 5 of MV) 71 - 37 -
Post surfactant administration (day 6 of MV) 72 No change 35 5%
Nitric oxide post Survanta administration PF % change OI % change
1 hr. into 2nd nitric oxide trial (day 6 of MV) 97 27%* 26 30%*
4 hrs. into 2nd nitric oxide trial (day 6 of MV) 97 27%* 26 30%*
8 hrs. into 2nd nitric oxide trial (day 6 of MV) 90 21%* 27 27%*
13 hrs. into 2nd nitric oxide trial (day 6 of MV) 98 28%* 22 41%*
*(20% change in the P/F or OI is considered a favorable response)

Conclusions: Upon review of this patient's course of illness and response to therapeutic interventions, it seems inhaled nitric oxide after Survanta administration yielded a more favorable response than nitric oxide alone or Survanta alone.

OF-99-054

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