Collective review: perioperative uses of inhaled nitric oxide in adults

Pulmonary arterial hypertension and hypoxemia constitute a significant cause of postoperative right heart failure and mortality. Timely administration of inhaled nitric oxide (iNO) can improve hemodynamic parameters and oxygenation in patients undergoing heart and/or lung transplantation and various high-risk cardiac procedures involving coronary artery bypass grafting and/or left ventricular assist device placement. As a diagnostic tool, iNO can be used to identify heart transplant recipients at high risk of right ventricular failure and patients with primary pulmonary hypertension who may benefit from vasodilator therapy. In addition to its role as a potent and selective pulmonary vasodilator, iNO is a useful intraoperative adjunct in adult cardiac surgery patients that may reduce the need for right ventricular assist device placement. This review focuses on the multiple clinical applications of iNO in perioperative patient care.