Therapy: Clinical Scenario
Thick meconium is passed during the delivery of a term infant. Immediately after birth, the trachea is intubated and suctioned for copious amounts of meconium. Despite intensive therapy which includes mechanical ventilation with pure oxygen and exogenous surfactant, the infant remains hypoxemic. Echocardiography confirms the presence of an anatomically normal heart and is consistent with the clinical diagnosis of Persistent Pulmonary Hypertension of the Newborn (PPHN). The resident asks whether to refer the patient to the Extracorporeal Membrane Oxygenation (ECMO) team in your tertiary care centre. You recently read about the benefits of inhaled nitric oxide and wonder whether this should be tried first.
You formulate the question, "In a term infant with hypoxic respiratory failure, does the use of inhaled nitric oxide decrease the need for ECMO?"
You start with Best Evidence. You enter the search term 'inhaled nitric oxide' and you find the abstract for the multi-centre trial of the Neonatal Inhaled Nitric Oxide Study Group. You review the abstract from Evidence Based Medicine (EBM) together with the original article N Engl J Med 1997; 336: 597-604.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?