Therapeutic use of inhaled nitric oxide

Nitric oxide is a gaseous endogenous mediator of vascular dilation, neural transmission, defense against microorganisms, and inhibitor of platelet adhesion. Endothelium-derived nitric oxide is important in the maintenance of normal vascular tone in the systemic and pulmonary circulation. The discovery of a selective pulmonary vasodilator has eluded investigators for many years. Inhaled nitric oxide can be used to selectively manipulate the pulmonary vasculature and represents an important advance in pharmacologic strategies aimed at the treatment of the diseased pulmonary circulation. Indeed, preliminary studies of the therapeutic use of inhaled nitric oxide in human pulmonary hypertension and respiratory failure are yielding encouraging and exciting results. Controlled and randomized studies will be required to show improvement in patient outcome and the absence of adverse sequelae from inhaled nitric oxide therapy.