Weaning strategy with inhaled nitric oxide treatment in persistent pulmonary hypertension of the newborn
a Department of Pediatrics, Columbia
University, 630 West 168th Street, New York, NY
10032, USA, b Department
of Anesthesia
Correspondence to: Dr Jen-Tien Wung.
Accepted 19 November 1996
AIM
To determine if infants who had become
dependent on inhaled nitric oxide treatment could be successfully
weaned off it if FIO2 was increased briefly during withdrawal.
METHODSSixteen infants admitted for
conditions associated with increased pulmonary vascular resistance
responded well to inhaled nitric oxide treatment with a significant
increase in PaO2 (maximum inhaled nitric oxide given 25 ppm). Weaning from inhaled nitric oxide in 5 ppm decrements was
initiated once the FIO2 requirement was less than 0.5. When
patients were stable on 5 ppm of inhaled nitric oxide, the gas was then
discontinued. If a patient showed inhaled nitric oxide dependencethat
is, oxygen saturation fell by more than 10% or below 85%inhaled
nitric oxide was reinstated at 5 ppm and the patient allowed to
stabilise for 30 minutes. At this time, FIO2 was increased
by 0.40 and weaning from inhaled nitric oxide was attempted again.
RESULTSNine infants were successfully weaned on
the first attempt. The seven infants who failed the initial trial were
all successfully weaned following the increase in FIO2.
After successful weaning, FIO2 was returned to the
pre-weaning level in mean 148(SD 51) minutes and inhaled nitric oxide
was never reinstated.
CONCLUSIONInfants showing inhaled nitric
oxide dependency can be successfully weaned by increasing
FIO2 transiently.
© 1997 by Archives of Disease in Childhood
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