Inhaled nitric oxide: therapeutic applications in cardiothoracic surgery

Hypoxemia and increased pulmonary vascular resistance can greatly complicate the management of cardiothoracic surgical patients. These complications are commonly found in the setting of thoracic organ transplantation, adult and pediatric cardiac surgical procedures, and general thoracic surgical procedures. Inhaled nitric oxide is a new therapy that promises to be extremely valuable to the cardiothoracic surgeon. It has been shown to improve oxygenation in the setting of acute lung injury and to selectively lower pulmonary vascular resistance, without producing unwanted systemic vasodilation. The purpose of this review is to discuss the biochemistry, toxicity, experimental studies, and therapeutic applications of inhaled nitric oxide administration in cardiothoracic surgical patients.