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Park, Lee, Oh, Lee, Sheen, and Hwang: Combined Effects of Inhaled Nitric Oxide and a Recruitment Maneuver in Patients with Acute Respiratory Distress Syndrome
Original Article
Yonsei Medical Journal

Yonsei Medical Journal 2003; 44(2): 219-226.

Published online: 30 March 2009

DOI: https://doi.org/10.3349/ymj.2003.44.2.219

Combined Effects of Inhaled Nitric Oxide and a Recruitment Maneuver in Patients with Acute Respiratory Distress Syndrome

Kwang Joo Park1, Young Joo Lee2, Yoon Jung Oh1, Keu Sung Lee1, Seung Soo Sheen1, Sung Chul Hwang1

1Department of Pulmonology, Ajou University School of Medicine, Suwon, Korea.

2Department of Anesthesiology, Ajou University School of Medicine, Suwon, Korea.

Reprint address: requests to Dr. Kwang Joo Park, Department of Pulmonology, Ajou University School of Medicine, San 5, Wonchon-dong, Paldal-gu, Suwon 442-749, Korea. Tel: 82-31-219-5121, Fax: 82-31-219-5109, parkkj@ajou.ac.kr

Received 4 September 2002       Accepted 21 November 2002

Copyright © 2003 The Yonsei University College of Medicine

Abstract

Nitric oxide (NO) inhalation therapy has been employed in the management of acute respiratory distress syndrome (ARDS), in order to improve oxygenation. Several factors have been implicated as being responsible for the action of inhaled NO. Alveolar recruitment methods, such as prone positioning and a sufficient positive end expiratory pressure (PEEP), have been identified as having a positive impact on the NO response. A Recruitment maneuver (RM) was introduced for the treatment of ARDS, along with a lung protective strategy. Here, we hypothesized that a RM may further augment the oxygenation of patients treated with NO inhalation. Therefore, the effects of the inhalation of NO, either in combination with a RM, or separately, were evaluated on patients with ARDS for their enhancing action.
23 patients with ARDS were enrolled, and divided into three groups. The patients in group 1 (n=11) were treated with 5 ppm NO via inhalation, followed by a RM, applying a sustained inflation pressure of 30 - 35 cmH2O for 30 seconds. Group 2 (n=6) received a RM alone, while group 3 (n=3) was treated with NO inhalation alone. The oxygenation and hemodynamic parameters were obtained prior to, and 2, 12, and 24 h after, the respective treatment procedures.
For group 1, the PaO2/FiO2 increased from its initial value of 171.8 ± 67.8 to 203.2 ± 90.0 2 h after NO inhalation. Further improvement was noted with the continual application of the RM reaching, 215.5 ± 74.6 (p=0.05) and 254.2 ± 109.5 (p < 0.05), after 12 and 24 h, respectively. Initially 7 of the subjects did not respond to NO inhalation, but 3 of these non-responders changed into responders 12 h after the RM. The changes in the PaO2/FiO2 from baseline at each time period were greater in group 1 than in the other groups, but with no statistical significance. The hemodynamics of the patients was not significantly altered during the entire study period.
We conclude that the combined application of NO inhalation and a RM could be beneficial and safe for patients with ARDS, showing an enhancing effect in improvement of oxygenation.

Keywords: ARDS (acute respiratory distress syndrome), nitric oxide inhalation, recruitment maneuver, treatment, oxygenation

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