42] Nitric oxide inhalation therapy in acute respiratory distress syndrome: Intended effects and possible side effects

Abstract

This chapter discusses the intended effects and possible side effects of nitric oxide (NO) inhalation therapy in acute respiratory distress syndrome. NO is an important regulator of the functions of the cardiovascular, immune, and nervous systems. The pulmonary hypertension in severe acute respiratory distress syndrome (ARDS), perioperative congenital heart diseases, and primary pulmonary hypertension of the newborn may be diseases associated with a lack of endogenous NO production within the pulmonary vasculature. Dose-response studies in patients with ARDS revealed that individual dose-response studies are required to determine the NO concentrations need to achieve a maximal improvement in arterial oxygenation and a maximal reduction in PAP, concentrations that might be different in an individual patient. It must be realized that the dose-response relationship may vary from day to day and that primary nonresponders may become responders a few days later. At present, no parameter or condition in severe ARDS shows that allows any prediction of the efficacy of inhaled NO. To demonstrate any increase in survival by adding NO inhalation to the standard treatment, large, controlled randomized trials are required.