Nitric oxide: Clinical applications in critically ill patients

Area of Science:

• Pulmonary medicine
• Critical care
• Pharmacology

Background:

• Inhaled nitric oxide (iNO) is FDA-approved for persistent pulmonary hypertension of the newborn.
• iNO effectively reduces pulmonary artery pressure and improves oxygenation in neonates.
• Preclinical studies suggest broad benefits, but high-quality clinical evidence is limited.

Purpose of the Study:

• To review the potential clinical applications of iNO beyond neonatal use.
• To summarize evidence for iNO in adult respiratory failure, pulmonary hypertension, and other conditions.
• To discuss iNO's safety, toxicity, and novel production strategies, including its use in COVID-19.

Main Methods:

• Narrative review of randomized controlled trials, meta-analyses, guidelines, observational studies, and case series.
• Comprehensive summary of preclinical and clinical literature on inhaled nitric oxide.
• Analysis of iNO's efficacy, safety, and potential applications.

Main Results:

• iNO demonstrates efficacy in improving oxygenation and reducing pulmonary artery pressure in newborns.
• Potential benefits are suggested for adult respiratory failure, pulmonary hypertension, and ischemia/reperfusion injury.
• Recent applications in COVID-19 are also explored, alongside toxicity data.

Conclusions:

• Inhaled nitric oxide shows promise for various clinical conditions.
• Further high-quality randomized clinical trials are essential to establish definitive therapeutic roles.
• Exploring novel production methods and comprehensive toxicity profiles is warranted.