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Hypoxic respiratory failure in term newborns: clinical indicators for inhaled nitric oxide and extracorporeal membrane oxygenation therapy.
J Crit Care. 2005 Sep; 20(3):288-93.JC

Abstract

PURPOSE

The criteria for starting extracorporeal membrane oxygenation (ECMO) therapy in term newborn patients with hypoxemic respiratory failure consist of an oxygenation index (OI) of 25 or higher and alveolar-arterial oxygen (Aao(2)) gradient of more than 600 at sea level. In such conditions, inhaled nitric oxide (iNO) may improve oxygenation and reduce the need for ECMO therapy. We studied early changes in OI and Aao(2) gradients in response to iNO treatment that may indicate a need to continue iNO treatment or the necessity to start an ECMO therapy.

MATERIALS AND METHODS

In this prospective study, we used 34 outborn neonatal patients that were referred to our pediatric critical care unit in a children's hospital for ECMO therapy with diagnosis of hypoxemic respiratory failure. In all patients, iNO therapy, starting at 80 ppm, was instituted either during transport or on arrival to hospital. Response to iNO was assessed after 1 hour, at which time, iNO concentration was reduced to 40 ppm, provided there was more than 20% improvement in either or both oxygenation indices. Patients who did not respond positively to continuous iNO therapy and met ECMO criteria were given ECMO therapy.

RESULTS

Inhaled nitric oxide therapy alone was successful in 10 (29%) of 34 patients. Eighteen patients (53%) required ECMO therapy within the first 10 hours of iNO treatment (early ECMO therapy), whereas 6 other neonates (18%) became eligible for ECMO therapy after prolonged (2-4 days) iNO treatment (late ECMO therapy). No mortality occurred with any treatment. Within 4 hours after iNO therapy, patients who required early ECMO therapy had significantly higher OI and Aao(2) gradients than patients who were treated with iNO therapy alone (P<.01, analysis of variance followed by Tukey-Kramer multiple comparison test). Six of 34 patients (18%), categorized as late ECMO therapy, on the average, had initially higher levels of OI and mean airway pressure than neonates in iNO treatment and early ECMO therapy.

CONCLUSION

Persisting levels of OI of more than 20 or Aao(2) gradients of more than 600 after 4 hours of iNO therapy could be indicative of an immediate need for ECMO therapy.

Authors+Show Affiliations

Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL 33155-3009, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16253800

Citation

Fakioglu, Harun, et al. "Hypoxic Respiratory Failure in Term Newborns: Clinical Indicators for Inhaled Nitric Oxide and Extracorporeal Membrane Oxygenation Therapy." Journal of Critical Care, vol. 20, no. 3, 2005, pp. 288-93.
Fakioglu H, Totapally BR, Torbati D, et al. Hypoxic respiratory failure in term newborns: clinical indicators for inhaled nitric oxide and extracorporeal membrane oxygenation therapy. J Crit Care. 2005;20(3):288-93.
Fakioglu, H., Totapally, B. R., Torbati, D., Raszynski, A., Sussmane, J. B., & Wolfsdorf, J. (2005). Hypoxic respiratory failure in term newborns: clinical indicators for inhaled nitric oxide and extracorporeal membrane oxygenation therapy. Journal of Critical Care, 20(3), 288-93.
Fakioglu H, et al. Hypoxic Respiratory Failure in Term Newborns: Clinical Indicators for Inhaled Nitric Oxide and Extracorporeal Membrane Oxygenation Therapy. J Crit Care. 2005;20(3):288-93. PubMed PMID: 16253800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypoxic respiratory failure in term newborns: clinical indicators for inhaled nitric oxide and extracorporeal membrane oxygenation therapy. AU - Fakioglu,Harun, AU - Totapally,Balagangadhar R, AU - Torbati,Dan, AU - Raszynski,Andre, AU - Sussmane,Jeffrey B, AU - Wolfsdorf,Jack, PY - 2004/11/15/received PY - 2005/03/18/revised PY - 2005/05/10/accepted PY - 2005/10/29/pubmed PY - 2006/2/2/medline PY - 2005/10/29/entrez SP - 288 EP - 93 JF - Journal of critical care JO - J Crit Care VL - 20 IS - 3 N2 - PURPOSE: The criteria for starting extracorporeal membrane oxygenation (ECMO) therapy in term newborn patients with hypoxemic respiratory failure consist of an oxygenation index (OI) of 25 or higher and alveolar-arterial oxygen (Aao(2)) gradient of more than 600 at sea level. In such conditions, inhaled nitric oxide (iNO) may improve oxygenation and reduce the need for ECMO therapy. We studied early changes in OI and Aao(2) gradients in response to iNO treatment that may indicate a need to continue iNO treatment or the necessity to start an ECMO therapy. MATERIALS AND METHODS: In this prospective study, we used 34 outborn neonatal patients that were referred to our pediatric critical care unit in a children's hospital for ECMO therapy with diagnosis of hypoxemic respiratory failure. In all patients, iNO therapy, starting at 80 ppm, was instituted either during transport or on arrival to hospital. Response to iNO was assessed after 1 hour, at which time, iNO concentration was reduced to 40 ppm, provided there was more than 20% improvement in either or both oxygenation indices. Patients who did not respond positively to continuous iNO therapy and met ECMO criteria were given ECMO therapy. RESULTS: Inhaled nitric oxide therapy alone was successful in 10 (29%) of 34 patients. Eighteen patients (53%) required ECMO therapy within the first 10 hours of iNO treatment (early ECMO therapy), whereas 6 other neonates (18%) became eligible for ECMO therapy after prolonged (2-4 days) iNO treatment (late ECMO therapy). No mortality occurred with any treatment. Within 4 hours after iNO therapy, patients who required early ECMO therapy had significantly higher OI and Aao(2) gradients than patients who were treated with iNO therapy alone (P<.01, analysis of variance followed by Tukey-Kramer multiple comparison test). Six of 34 patients (18%), categorized as late ECMO therapy, on the average, had initially higher levels of OI and mean airway pressure than neonates in iNO treatment and early ECMO therapy. CONCLUSION: Persisting levels of OI of more than 20 or Aao(2) gradients of more than 600 after 4 hours of iNO therapy could be indicative of an immediate need for ECMO therapy. SN - 0883-9441 UR - https://www.unboundmedicine.com/medline/citation/16253800/Hypoxic_respiratory_failure_in_term_newborns:_clinical_indicators_for_inhaled_nitric_oxide_and_extracorporeal_membrane_oxygenation_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(05)00059-6 DB - PRIME DP - Unbound Medicine ER -