Inhaled nitric oxide for ARDS: searching for a more focused use

Excerpt

The advent of nitric oxide (NO) inhalation for patients with the acute respiratory distress syndrome (ARDS) 10 years ago [1] was hailed by many as a possible breakthrough in the treatment of hypoxemic acute respiratory failure. A low dose of inhaled NO selectively decreased pulmonary artery pressure and redistributed pulmonary blood flow to ventilated alveoli, increasing the PaO₂ [2]. Even though it was not a causal therapy (pulmonary hypertension is seldom responsible for the demise of ARDS patients), it was reasonable to predict that the effect of inhaled NO on gas exchange would permit a decrease in the intensity of mechanical ventilation, limit ventilator-induced lung injury, and ultimately increase survival. Also, additional effects of NO through different biochemical pathways conceivably could prevent local inflammatory and cytotoxic processes, thereby limiting the endothelial and epithelial damage characteristic of ARDS [3, 4]. The proven benefit of NO inhalation in neonates with hypoxemic respiratory failure [5, 6] seemed to provide insurance for a similarly tangible outcome in adults. …