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Inhaled nitric oxide in acute respiratory distress syndrome
J A Johannigman1, K Davis, R S Campbell
1Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558, USA.
The Journal of Trauma
|January 7, 1998
Summary
Inhaled nitric oxide (NO) improved oxygenation in 65% of acute respiratory distress syndrome (ARDS) patients. Doses under 10 ppm may benefit ARDS patients needing higher oxygen support.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Pharmacology
Background:
- Inhaled nitric oxide (NO) is a selective pulmonary vasodilator.
- Previous studies suggest NO improves oxygenation in select patients with acute respiratory distress syndrome (ARDS).
Purpose of the Study:
- To evaluate the clinical response to four concentrations of inhaled nitric oxide (NO) in patients with ARDS.
- To determine optimal dosing for inhaled NO in ARDS management.
Main Methods:
- Twenty patients with ARDS received inhaled NO at random doses (1, 15, 30, 60 ppm) for 3-hour periods.
- Continuous cardiovascular monitoring and arterial/mixed venous blood gas measurements were performed.
- ARDS diagnosis criteria included predisposing factors, PaO2/FiO2 ratio < 200, and bilateral infiltrates.
Main Results:
- 65% of patients (13/20) showed a significant PaO2/FiO2 increase (>20%) with inhaled NO.
- Oxygenation improved at 1, 15, and 30 ppm, but not 60 ppm; doses >1 ppm did not significantly enhance response.
- Pulmonary artery pressure decreased with increasing NO concentration; survival was higher in responders.
Conclusions:
- Inhaled NO effectively increased PaO2/FiO2 in a majority of ARDS patients.
- Response to NO could not be predicted by baseline parameters.
- A trial of inhaled NO at doses <10 ppm may be beneficial for ARDS patients requiring increased FiO2 and PEEP.
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