The effect of inhaled nitric oxide on pulmonary function in preterm infants

Fiore, Juliann M. Di; Hibbs, Anna Maria; Zadell, Arlene; Merrill, Jeffrey D.; Eichenwald, Eric C.; Puri, Asha; Mayock, Dennis E.; Courtney, Sherry E.; Ballard, Roberta A.; Martin, Richard J.

doi:10.1038/sj.jp.7211830

Cited by 13 publications

(6 citation statements)

References 25 publications

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“…Some reports have been published describing no significant effects of inhaled NO on respiratory system resistance in preterm infants [26,27], also affected by the respiratory syncytial virus [28]. Belik et al [29] showed that the content and the activity of the NOS competitor arginase in the rat lungs exhibit significant reduction with increasing age of the animals, from fetal life to newborns and adults.…”

Section: Discussionmentioning

confidence: 99%

The Effect of NG-Nitro-L-Arginine Methyl Ester, a Nitric Oxide Synthase Inhibitor, on Respiratory Mechanics in Rats

Rubini

2011

Respiration

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Background: Data describing the inhibitory effects of nitric oxide synthase (NOS) on respiratory mechanics are conflicting, and no data are available concerning possible effects on the viscoelasticity of the respiratory system, on the inspiratory work of breathing (WOB) or on respiratory system hysteresis. Objectives: The aim of this study was to measure the effects of NOS inhibition by N^G-nitro-L-arginine methyl ester (L-NAME) on respiratory mechanics in normal anesthetized rats. Methods: Using the end-inflation occlusion method, it was possible to quantify the ohmic and viscoelastic airway resistance and elastance of the respiratory system. Ohmic resistance is the normalized-to-flow pressure dissipation due to viscous forces opposing the airflow in the airways, as predicted by the Poiseuille law. Viscoelastic resistance is the normalized-to-flow pressure dissipation due to the resistance of respiratory system tissue to deformation during inflation, which is recovered after the arrest of the inspiratory flow (stress relaxation). The inspiratory WOB, its elastic and resistive components, and hysteresis were also calculated. Results:L-NAME induced an increment in the ohmic airway resistance and in the resistive ohmic inspiratory WOB. The viscoelastic resistance due to stress relaxation and the elastic properties of the respiratory system were not modified, and no effect was detected on the related components of the inspiratory WOB and on hysteresis. Conclusions: NO acts in normal rats to reduce the ohmic component of airway resistance, decreasing the ohmic inspiratory WOB. The elastic and viscoelastic components are unaltered. Hysteresis is also unaltered, suggesting that NO has negligible effects on alveolar surfactant activity.

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Section: Discussionmentioning

confidence: 99%

The Effect of NG-Nitro-L-Arginine Methyl Ester, a Nitric Oxide Synthase Inhibitor, on Respiratory Mechanics in Rats

Rubini

2011

Respiration

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“…BPD is a multifactorial chronic lung disease characterized by prolonged oxygen dependency, increased airway flow resistance and airway reactivity, decreased dynamic compliance, decreased FRC, and may be associated with significant long‐term morbidity in later life. Pulmonary function testing using different methods has been reported in numerous studies of neonates with RDS and BPD to objectively evaluate baseline disease severity, history, and disease predictive value as well as the effect of interventions such as surfactant, steroids, theophylline, bronchodilators, diuretics, inhaled nitric oxide, and ventilation . A state‐of‐the art critical review, focusing on respiratory mechanics, has been published recently by Gappa et al to summarize and discuss available data on PFT's performed on neonates and infants with chronic lung disease .…”

Section: Clinical Applications and Usefulness Of Pulmonary Mechanicsmentioning

confidence: 99%

Evaluation of bedside pulmonary function in the neonate: From the past to the future

Reiterer

Sivieri

Abbasi

2015

Pediatric Pulmonology

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Pulmonary function testing and monitoring plays an important role in the respiratory management of neonates. A noninvasive and complete bedside evaluation of the respiratory status is especially useful in critically ill neonates to assess disease severity and resolution and the response to pharmacological interventions as well as to guide mechanical respiratory support. Besides traditional tools to assess pulmonary gas exchage such as arterial or transcutaenous blood gas analysis, pulse oximetry, and capnography, additional valuable information about global lung function is provided through measurement of pulmonary mechanics and volumes. This has now been aided by commercially available computerized pulmonary function testing systems, respiratory monitors, and modern ventilators with integrated pulmonary function readouts. In an attempt to apply easy-to-use pulmonary function testing methods which do not interfere with the infant́s airflow, other tools have been developed such as respiratory inductance plethysmography, and more recently, electromagnetic and optoelectronic plethysmography, electrical impedance tomography, and electrical impedance segmentography. These alternative technologies allow not only global, but also regional and dynamic evaluations of lung ventilation. Although these methods have proven their usefulness for research applications, they are not yet broadly used in a routine clinical setting. This review will give a historical and clinical overview of different bedside methods to assess and monitor pulmonary function and evaluate the potential clinical usefulness of such methods with an outlook into future directions in neonatal respiratory diagnostics.

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“…16 Di Fiore et al, reported that the mean Rrs level on inhaled nitric oxide in preterm infants was 231 ± 71 cmH 2 O･kg/L/s. 17 Therefore, a reference Rrs range between 150 and 350 cmH 2 O･kg/L/s is likely an optimal value for infants with CDH. Rrs levels higher than this range might indicate the presence of additional factors that complicate effective ventilation management.…”

Section: Discussionmentioning

confidence: 99%

Respiratory function testing for guiding ventilator mode conversion in congenital diaphragmatic hernia

Kimura,

Toyoshima,

Shimokaze

et al. 2024

Pediatric Pulmonology

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IntroductionFor patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high‐frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion‐ and HFOV‐preferred treatment groups.MethodsVentilator settings and blood gases were retrospectively evaluated pre‐ and post‐CMV conversion, and respiratory function tests for compliance of the respiratory system (Crs) and for resistance of the respiratory system (Rrs) were performed during the trial to CMV conversion.ResultsNo differences were observed between the CMV conversion‐ and HFOV‐preferred groups regarding gestational age, birth weight, and observed/expected lung area‐to‐head circumference ratios. The median Crs (ml/cmH2O/kg) and Rrs (cmH2O･kg/L/s) in the CMV conversion‐ and HFOV‐preferred groups was 0.42 versus 0.53 (p = .44) and 467 versus 327 (p = .045), respectively. The pre and posttrial amount of change in blood gas levels and ventilator parameters in the CMV conversion‐ and HFOV‐preferred groups were as follows: mean airway pressure, −2.0 versus 0 cmH2O; partial pressure of carbon dioxide, 6.1 versus 2.9 Torr; alveolar‐arterial oxygen difference, −39.5 versus −50 Torr; and oxygenation index, −1.0 versus −0.6; respectively.ConclusionRespiratory function tests were useful in tailoring ventilator settings. Patients with high Rrs values responded better to CMV conversion.

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The effect of inhaled nitric oxide on pulmonary function in preterm infants

Cited by 13 publications

References 25 publications

The Effect of N<sup>G</sup>-Nitro-<i>L</i>-Arginine Methyl Ester, a Nitric Oxide Synthase Inhibitor, on Respiratory Mechanics in Rats

The Effect of N<sup>G</sup>-Nitro-<i>L</i>-Arginine Methyl Ester, a Nitric Oxide Synthase Inhibitor, on Respiratory Mechanics in Rats

Evaluation of bedside pulmonary function in the neonate: From the past to the future

Respiratory function testing for guiding ventilator mode conversion in congenital diaphragmatic hernia

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