The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

NITRIC OXIDE FOR A POST-OP CARDIAC SURGERY PATIENT: A CASE REPORT

Suzanne M. Durning BS, RRT, Theresa R. Schultz BA, RRT, CPFT, RN, Linda A. Napoli BS, RRT, RPFT, Rodolfo I. Godinez MD, PhD. The Children's Hospital of Philadelphia, Philadelphia, PA

Background: A four month old male with Trisomy 21 was referred to our institution for surgical correction of his cardiac defect. Echocardiography results were complete AV canal slightly unbalanced to the right ventricle, large unrestrictive VSD with bi-directional shunting, large ASD with left to right shunting, moderate to severe pulmonary hypertension and trivial AV valve regurgitation. The patient underwent a pulmonary artery banding and PDA ligation. He was extubated six hours post op with supplemental oxygen of one lpm nasal cannula with saturations in the 80's. Twenty-four hours post op the patient had an acute desaturation to the 40's with a slightly increased heart rate. This desaturation episode was successfully treated by increasing the supplemental oxygen via nasal cannula. However, thirty two hours post op the patient's SpO2 fell into the 40's and he was noted to have an increased work of breathing at this time. The lungs on chest x-ray were described as hazy and lasix therapy was initiated. The patient was placed in a 60% oxygen hood, sedated to decrease work of breathing and transfused with 60 cc PRBC's to increase oxygen carrying capacity. The patient continued to deteriorate despite these interventions. Due to the significant lability of the oxygen saturations which may be caused by decreased pulmonary blood flow secondary to elevated distal pulmonary vascular resistance, nitric oxide therapy was initiated. Patient management otherwise remained constant. The patient was given 20 ppm Nitric Oxide with supplemental O2. Blood gas results were as follows:

Pre Nitric Oxide Post Nitric Oxide
PH 7.33 PH 7.37
PCO2 49 PCO2 42
PaO2 43 PaO2 62
HCO3 25 HCO3 25
B.E. -0.9 B.E. 0.4
SpO2 75% SpO2 91%

The nitric oxide was weaned to 2 ppm over the next twenty four hours and weaned off within the next 32 hours. The patient remained on [one-half] lpm nasal cannula with SpO2's in the 80's.
Conclusion: Nitric oxide seemed to be useful in improving the pulmonary blood flow in a post operative 5 month old cardiac surgery patient.

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