• Anke P C Top, Can Ince, Patrick H M Schouwenberg, and Dick Tibboel.
• Erasmus Medical Center-Sophia Children's hospital, Rotterdam, the Netherlands. anke.top@addenbrookes.nhs.uk
• Pediatr Crit Care Me. 2011 Nov 1;12(6):e271-4.

ObjectivesTo investigate the effect of inhaled nitric oxide on the systemic microcirculation. We hypothesized that inhaled nitric oxide improves the systemic microcirculation. Inhaled nitric oxide improves outcome in infants with persistent pulmonary hypertension of the newborn diagnosed by improving pulmonary blood flow and oxygenation. It reduces pulmonary vascular resistance without decline in systemic blood pressure. Inhaled nitric oxide is also utilized in the treatment of acute hypoxemic respiratory failure in children and adults. It is thought to improve regional ventilation perfusion by regional selective pulmonary vasodilation.DesignPilot study.SettingIntensive care unit of a level III university children's hospital.PatientsConsecutive ventilated patients who were treated with inhaled nitric oxide (20 ppm) were enrolled in this study. Eight patients (five boys, three girls) were included; five had congenital diaphragmatic hernia diagnosed, one had persistent pulmonary hypertension of the newborn diagnosed, one had acute respiratory distress syndrome diagnosed, and one had bronchiolitis diagnosed. The median age was 0 months (range, 0-38 months).InterventionsInhaled nitric oxide administration.Measurements And Main ResultsThe microcirculation was assessed in the buccal mucosa within 1 hr before and within 1 hr after the start of inhaled nitric oxide using orthogonal polarization spectral imaging. The median functional capillary density before the inhaled nitric oxide was started was 4.0 cm/cm (range, 1.8-5.6 cm/cm) and improved to 4.9 cm/cm (range, 2.8-6.6 cm/cm; p = .017) after the start of inhaled nitric oxide.ConclusionsInhaled nitric oxide improves the systemic microcirculation in children with hypoxemic respiratory failure.

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