Abstract
In persistent pulmonary hypertension of neonate (PPHN), inhaled NO dilates pulmonary vessels and reduces right-to-left extrapulmonary shunt improving arterial oxygen pressure. It is indicated for the treatment of term and near-term neonates with hypoxic respiratory failure with pulmonary hypertension, in which NO inhalation improve oxygenation and reduces the need for extracorporeal membrane oxygenation (ECMO), an invasive and expensive therapy. NO-treated patient may have less incidence of cerebral hemorrage and chronic lung disease. In addition, NO inhalation reduces perioperative pulmonary hypertension in cardiac surgery and increase pulmonary blood flow in Fontan type operation, which may be another indication of inhaled NO. In respiratory failure, NO inhalation improve oxygenation, but mortality is similar with patients treated without NO. Concentration of inhaled NO is different among reports. It is recommended to investigate doseresonse in indivisual patient. The effect of 20ppm NO is similar with 80ppm NO in most patients. Five ppm may be enough. Effects of NO may be evaluated at least after 15 minutes after the start of inhalation in PPHN, and within 30 minutes after the start of inhalation in perioperative period of cardiac surgical patients.
