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The Weaning Method of Inhaled Nitric Oxide

Journal of the Korean Pediatric Society 2001;44(4):413-417.
Published online April 15, 2001.
The Weaning Method of Inhaled Nitric Oxide
Hyun Woo Lee1, Jae Woong Lee1, Sung Yeul Hyun1, Ha Chang Lee1, Chul Hyun Park1, Kook Yang Park1, Hyeon Su Yoo2, Kyung Cheon Lee3, Young Jin Jang3
1Department of Thoracic and Cardiovascular Surgery, Gachon Medical School, Inchon, Korea
2Department of Pediatrics, Gachon Medical School, Inchon, Korea
3Department of Anesthesiology, Gachon Medical School, Inchon, Korea
흡입성 산화질소의 이탈방법
이현우1, 이재웅1, 현성열1, 이창하1, 박철현1, 박국양1, 유현수2, 이경천3, 장영진3
1가천의과대학 길병원 흉부외과
2가천의과대학 길병원 소아과
3가천의과대학 길병원 마취과
Hyun Woo Lee, Email: ljh@ghil.com
: Inhaled nitric oxide(iNO) is an excellent method for the postoperative pulmonary hypertension in congenital heart disease. But more detailed care is needed because of the development of rebound pulmonary hypertension after NO withdrawal. We performed this study in order to discontinue the iNO successfully by way of presenting the adequate weaning and supplying methods.
: Between January, 1998 and August, 1999 we studied 10 patients who had rebound pulmonary hypertension(RPH) after iNO withdrawal. We completed the iNO in these patients through the second trial of the weaning process. We tried to discover the differences between the first and second weaning process. We measured NO concentration at the start and just before NO withdrawal and during the period of weaning process. Moreover, to identify the iNO effects during the weaning of the iNO, we counted the degree of the change of PaO2/FiO2 and mean PAP/ SAP between initial and at half of the initial NO concentration.
: Second weaning had a longer duration weaning process(11¡¾10 versus 5¡¾3 hours, P< 0.05), lower NO concentration just before NO withdrawal(2¡¾0.6 versus 4¡¾1ppm, P<0.05). In the change of the mean PAP/SAP and PaO2/FiO2 as iNO was weaning from the initial iNO concentration to a half of the initial iNO concentration, the degree of increase in mean PAP/SAP(0.026¡¾0.07 versus 0.054¡¾0.07, P<0.05) and the degree of decrease in PaO2/FiO2(49¡¾54 versus 65¡¾72, P<0.05) were smaller in the second weaning process than the first weaning process.
: A successful weaning of iNO can be performed with a low iNO concentration at the start and just before withdrawal and with the long duration iNO weaning process. Moreover, We speculate that the degree of change in the mean PAP/SAP and PaO2/FiO2 at the half of the iNO weaning process are an indicator for the development of RPH.
Key Words: Inhaled nitric oxide, Weaning, Rebound pulmonary hypertension

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