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Initial Oxygenation Response to Inhaled Nitric Oxide Predicts Improved Outcome in Congenital Diaphragmatic Hernia.
[congenital diaphragmatic hernia]
Pulmonary
hypertension
(
PH
)
is
the
most
important
complication
of
congenital
diaphragmatic
hernia
(
CDH
)
and
still
has
a
high
mortality
rate
.
The
aim
of
this
study
was
to
evaluate
the
effectiveness
of
inhaled
nitric
oxide
therapy
in
PH
due
to
CDH
.
Hospital
records
of
children
who
had
undergone
inhaled
nitric
oxide
therapy
for
PH
due
to
CDH
between
June
2009
and
December
2011
were
reviewed
.
Twenty
-
nine
patients
had
a
diagnosis
of
CDH
at
the
time
of
study
,
and
eight
of
these
patients
underwent
nitric
oxide
therapy
because
of
failure
of
conventional
ventilation
techniques
,
which
was
successful
in
five
of
these
patients
.
Patients
who
had
a
good
overall
outcome
of
nitric
oxide
therapy
experienced
rapid
improvement
(
pretreatment
,
mean
PaO
2
Â
=
Â
44
.
8
Â
mmHg
;
after
the
first
hour
of
therapy
,
mean
PaO
2
Â
=
Â
96
.
8
Â
mmHg
)
,
whereas
patients
with
no
response
did
not
have
a
similar
course
(
pretreatment
,
PaO
2
Â
=
Â
37
Â
mmHg
;
after
the
first
hour
,
PaO
2
Â
=
Â
54
.
6
Â
mmHg
)
.
Inhaled
nitric
oxide
therapy
seems
to
increase
survival
in
PH
due
to
CDH
.
No
predictive
parameters
to
orient
patient
selection
could
be
identified
;
however
,
the
early
response
seemed
to
predict
the
overall
outcome
.
Good
results
in
our
series
were
attributed
to
routine
use
of
sildenafil
and
dopamine
,
along
with
the
nitric
oxide
inhalation
.
