Eine Standortbestimmung zum Einsatz von inhalativem Stickstoffmonoxid

Abstract

Since the first clinical use of inhaled nitric oxide (iNO) as a selective pulmonary vasodilator, the concept of NO inhalation has been investigated for various indications. Used in the therapy of acute respiratory distress syndrome (ARDS), it has shown positive effects on intrapulmonary shunting and oxygenation, but no change on ARDS mortality has been demonstrated so far. Perhaps the combination of iNO with other therapeutic interventions, such as the increase of the hypoxic pulmonary vasoconstriction response through almitrine, will lead to a reduction in the mortality of the ARDS. In the treatment of persistent pulmonary hypertension of the newborn, iNO has been shown to be advantageous. Although the influence on the mortality rate has not yet been proven, a reduced need for extracorporeal membrane oxygenation (ecmo) through the use of iNO has been demonstrated. In addition, NO inhalation has been successful in the postoperative care of children after repair of congenital heart defects. There may be a special role for inhalation of NO in the prophylaxis of early complications after heart or lung transplantation if right heart failure after heart transplant or edema due to reperfusion injury after lung transplant becomes the main problem. Due to the different effects of NO, e.g., in clotting and the immunsystem, further investigations will be needed to complete our knowledge on the clinical use of NO inhalation.