ABSTRACT
OBJECTIVES: To compare the effects of 5 and 20 ppm of nitric oxide, evaluating time until response for each dose, in patients with adult respiratory distress syndrome (ARDS). PATIENTS AND METHODS: The study was prospective, controlled and random. Fifteen patients assigned to two groups received either 5 ppm (8 patients) or 20 ppm (7 patients) from November 96 to July 97. The main variables analyzed were PaO2/FiO2 and pulmonary vascular resistance index. We also studied etiology, severity of pulmonary damage as reflected by the Lung Injury Score, age, sex, Apache II prognostic score and exitus. Outcome was considered good if PaO2/FiO2 increased and/or pulmonary vascular resistance index decreased by more than 30% from the initial level (before inhalation of nitric oxide). RESULTS: The mean lung injury score was 2.9 +/- 0.4 and the two groups were homogeneous. Time until response to nitric oxide was significantly less in the 20 ppm group. Both PaO2/FiO2 and pulmonary vascular resistance index improved significantly in both groups whereas Qs/Qt improved only in the 20 ppm group. We also found that cardiac index and oxygen transport increased, the latter significantly only in the 20 ppm group. NO2 formation was less than 2 ppm and methemoglobin levels did not rise above 2%. CONCLUSIONS: Inhaled nitric oxide significantly improves oxygenation and decreases pulmonary vascular resistance without altering systemic vascular resistance during treatment of ARDS. The final outcomes were similar for both doses, but the 20 ppm dose produced a significantly faster response as well as a significant decrease in Qs/Qt.
Subject(s)
Bronchodilator Agents/administration & dosage , Nitric Oxide/administration & dosage , Respiratory Distress Syndrome/physiopathology , Administration, Inhalation , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Objetivos. Comparar los efectos respectivos de 5 y 20 partes por millón (ppm) evaluando el tiempo de respuesta de ambas dosis, en pacientes con síndrome de distrés respiratorio del adulto.Métodos. El estudio fue prospectivo, controlado y aleatorio. Se estudió a 15 pacientes divididos en dos grupos, que recibían dosis de 5 ppm (grupo 5 ppm: 8 pacientes) o bien de 20 ppm (grupo 20 ppm: 7 pacientes), entre noviembre de 1996 y julio de 1997. Las variables principales analizadas fueron el índice PaO2/FiO2 y el índice de resistencias vasculares pulmonares. También se estudiaron la etiología, la gravedad de la lesión pulmonar según la Lung Injury Score (LIS), la edad, el sexo, el índice pronóstico APACHE II y la mortalidad. Se consideró resultado positivo el aumento del PaO2/FiO2 y/o la disminución del índice de resistencias vasculares pulmonares en más del 30 por ciento de los valores previos a la inhalación de NO.Resultados. El valor medio del LIS fue de 2,9 ñ 0,4. Los dos grupos eran homogéneos. El tiempo de respuesta al NO fue significativamente inferior en el grupo 20 ppm. Tanto el PaO2/FiO2 como el índice de resistencias vasculares pulmonares mejoraron significativamente en los dos grupos, y el Qs/Qt sólo en el grupo 20 ppm. También se observó aumento en el índice cardíaco y transporte de O2, que fue significativo sólo en el grupo 20 ppm. La formación de NO2 fue inferior a 2 ppm y la metahemoglobina no superó el 2 por ciento.Conclusiones. La inhalación de NO produjo mejoría significativa en la oxigenación y disminuyó significativamente las resistencias vasculares pulmonares, sin alterar las resistencias vasculares sistémicas, durante el tratamiento del síndrome de distrés respiratorio del adulto. Los efectos finales de ambas dosis fueron similares, pero las dosis de 20 ppm produjeron una respuesta significativamente más temprana y una disminución del Qs/Qt también significativa (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Respiratory Distress Syndrome , Prospective Studies , Bronchodilator Agents , Administration, Inhalation , Nitric OxideABSTRACT
BACKGROUND: Percutaneous tracheotomy (PT) has become an alternative to conventional surgical tracheotomy (CST) in recent years. Our aim was to compare the advantages and disadvantages of the two techniques in our intensive care unit (ICU). PATIENTS AND METHODS: Two patient groups were compared. Sixty underwent PT and 47 underwent CST, and all were admitted to the ICU between May 1995 and August 1997. PT was performed in 49 by way of progressive dilations, and 11 were performed by Griggs' method using a dilator. Variables studied were age, sex, reason for admission, APACHE II upon admission to the ICU, duration of technique, and immediate and late complications. Statistical analysis was provided by applying a Student t test to contrast quantitative variables and a chi-squared test to compare proportions. RESULTS: The following variables were significantly different. APACHE II upon admission was 18 +/- 5 in the PT group and 15 +/- 6 in the CST group (p < 0.002). Duration of the procedure was 15 +/- 4 minutes in the PT group and 36 +/- 11 in the CST group (p < 0.005). Complications after tracheotomy in PT group patients consisted of 1 false line during a change of cannula and 1 late tracheoesophageal fistula. Complications in the CST group included 16 episodes of slight bleeding, 9 stoma infections, 3 cases of pneumothorax, 2 of bad scarring of the stoma and 1 late fistula (p < 0.005). Time of follow-up was 41 to 76 days for PT patients and 32 to 51 days for CST patients. CONCLUSIONS: PT is a fast, simple procedure that is easy to manage and requires fewer resources (operating theater, personnel and equipment) and causes fewer medium-term complications than does CST.
