High Frequency Oscillatory Ventilation with Inhaled Nitric Oxide Combined Therapy in The Intractable Respiratory Failure Neonates

Lee, Mi Hyun; Han, Ji Eun; Lee, Sang Geel

Abstract

PURPOSE
Inhaled nitric oxide(iNO) has been known to improve oxgenation in newborns with persistent pulmonary hypertension(PPHN), but it's not clear that iNo treatment is effective in cases of acute, hypoxic respiratory failure and premature infants. In our study, high frequency oscillatory ventilation(HFV) with iNO combined therapy was tried in intractable respiratory failure neonates who showed no response to conventional ventilator therapy.
METHODS
Between May 2000 and December 2002, 18 newborns with intractable respiratory failure were treated with HFV with iNO combined therapy. According to the respective response times, the newborns were divided into rapid, intermediate, and non-response groups. Clinical response was defined as when the oxygenation index(OI) was reduced more than 20%.
RESULTS
Six neonates(33.3%) showed a rapid response, eight(44.4%) an intermediate response, and four(22.2%) no response. Four had PPHN(22.2%), Three meconium aspiration syndrome(16.7%), three pneumonia(33.3%), and two sepsis(11.1%). Six neonates(33.3%) died, five from respiratory distress syndrome(RDS) and one from sepsis. Of them, one was a full-term neonate and five were premature infants under 35 weeks. Their complications were pneumothorax, pulmonary hemorrhage, pulmonary edema, and congestive heat failure.
CONCLUSION
HFV with iNo combined therapy is not effective in intractable respiratory failure, lower gestational age, RDS, and sepsis. However, iNO may be beneficial to patients with acute, hypoxic respiratory failure.