[Effects of prone position, inhaled nitric oxide and surfactant in children with hypoxemic pulmonary disease]. / Efecto del óxido nítrico, la postura en prono y la administración de surfactante en niños con enfermedad pulmonar hipoxémica.

ABSTRACT

OBJECTIVE: To analyze the therapeutic response to prone position, inhaled nitric oxide (NO) and surfactant in children with hypoxemic pulmonary disease. PATIENTS AND METHODS: We studied the effect of prone position, NO, and surfactant in critically ill children with acute hypoxemic pulmonary disease unresponsive to conventional therapy. We analyzed PaO2, SatO2, the PaO2/FiO2 ratio, oxygenation index and PaCO2 before and after each treatment, as well as the subsequent clinical course. An increase of more than 20 % in the PaO2/FiO2 ratio was considered a positive response. RESULTS: Ninety treatments were administered in 56 patients 55 patients were treated with NO, 18 with prone position and 17 with surfactant. All three treatments substantially improved oxygenation. The mean increase in the PaO2/FiO2 ratio was 35 % with nitric oxide, 33 % with prone position and 50 % with surfactant. The mean decrease in oxygenation index was 22 % with nitric oxide, 24 % with prone position and 17 % with surfactant. Seventy-one percent of patients treated with NO, 61 % of patients treated with prone position, and 64 % of patients who received surfactant were responders. The three treatments produced a slight decrease in PaCO2 (2.5 mmHg with nitric oxide, 4.7 mmHg with prone position and 5.1 mmHg with surfactant). CONCLUSIONS: Inhaled NO, prone position and surfactant improve oxygenation in some children with hypoxic pulmonary disease.