PPV induced acute and sustained improvement in oxygenation in many patients with ARDS. The sustained improvement is more significant if PPV is administered early to patients with a larger shunt and a more compliant chest wall. Measuring venous admixture and chest wall compliance before PPV may help select a subgroup of patients with ARDS who may benefit the most from PPV.

Heliox may be a useful adjunct therapy in patients with severe chronic obstructive pulmonary disease during acute respiratory failure who have persistent intrinsic positive end-expiratory pressure-induced hemodynamic changes despite ventilator management.

Background: Inhaled nitric oxide (INO) can improve hypoxemia and reduce pulmonary hypertension, but there is a wide range of response to INO. Objectives: The aim of this study was to evaluate the effect of different INO concentrations in acute respiratory distress syndrome (ARDS) patients. Methods: Thirty-two adult ARDS patients who were supported by mechanical ventilator were included. INO was given at a concentration of 1, 5, 10, 20 and 40 ppm, sequentially. Arterial blood gas and mean pulmonary artery pressure (MPAP) were measured 30 min after INO concentrations changed. Results: There was a significant increase in PaO₂/FiO₂ (p < 0.0001) and a decrease in pulmonary vascular resistance index and MPAP (p < 0.0001) after INO use. INO concentrations required for improving oxygenation were in the range of 1–20 ppm, whereas concentrations required for decreasing MPAP were in the range of 1–40 ppm. PaO₂/FiO₂ worsened when the INO dose was adjusted above 20 ppm. Sixty-nine percent of ARDS patients were responders; 31% of them were nonresponders. Among responders, 64% of patients responded at 1 ppm, 36% at 5 ppm. Conclusions: The optimal doses for improving oxygenation and reducing PAP differ. The maximum PaO₂/FiO₂ was observed at a lower INO concentration than that required for the minimal MPAP. There was no further improvement in PaO₂/FiO₂ when the INO dose was adjusted above 20 ppm. Higher doses of INO treatment worsened oxygenation.