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J Trauma Inj > Volume 28(3); 2015 > Article
Journal of Trauma and Injury 2015;28(3):104-107.
DOI: https://doi.org/10.20408/jti.2015.28.3.104    Published online September 30, 2015.
Therapeutic Role of Inhaled Nitric Oxide for Acute Respiratory Failure in the Early Phase of Trauma
Byoung Sung Kim, Kyu Hyouck Kyoung, Hojong Park
Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. dc911joy@hanmail.net
외상환자의 초기 호흡 부전에 대한 흡입산화질소의 적용
김병성, 경규혁, 박호종
울산대학교병원 외과
Received: 7 June 2015   • Revised: 24 August 2015   • Accepted: 4 October 2015
Abstract
PURPOSE
Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia.
METHODS
We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as PaO2/FiO2 ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality.
RESULTS
A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%.
CONCLUSION
Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.
Key Words: Trauma; Inhaled nitric oxide; Respiratory failure; Acute respiratory distress syndrome
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