Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults

Abstract

GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate a Sensitivity analysis excluding trials published as abstracts did not change the overall mortality e ect estimate b The outcome was upgraded from low to moderate quality of evidence because most trials had moderate risk of bias c The outcome was upgraded from moderate to high quality of evidence because most trials had low risk of bias

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study

“…Subsequent studies showed similar improvements in oxygenation in a dosedependent manner without better outcomes [10]. Multiple systematic reviews have shown that iNO does not reduce the mortality among patients with ARDS, nor does it shorten the duration of mechanical ventilation and it may even increase the incidence of renal impairment [9]. Nevertheless, one study showed that low iNO doses (< 5 ppm) improved lung function in ARDS survivors at 6 months [15].…”

“…Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that has long been used in the management of acute respiratory distress syndrome (ARDS), pulmonary hypertension, neonatal hypoxemic respiratory failure, and lung transplantations. To date, several randomized controlled trials and meta-analyses have concluded that iNO therapy wasn't beneficial to mortality or mechanical ventilation duration of patients with ARDS [9,10]. However, postoperative hypoxemia in AADA was different with ARDS in etiology and pathophysiology.…”

Protocol of a randomized controlled trial testing inhaled Nitric Oxide in mechanically ventilated patients with severe acute respiratory syndrome in COVID-19 (SARS-CoV-2)

“…However, NO gas has been advocated as rescue treatment in adults with hypoxic ARDS [8]. Treatment with iNO reversed pulmonary hypertension, improved remarkably severe hypoxemia and shortened the length of ventilatory support as compared to matched control patients with SARS-CoV [9].…”

Prone positioning in acute respiratory distress syndrome: why aren’t we using it more?

“…We agree with Li et al that this is an alarming trend given the proven efficacy and cost effectiveness of PP compared to ECMO. Other rescue therapies, such as inhaled nitric oxide, have been found to improve gas exchange, but have not offered survival benefit in ARDS; therefore, they are also poor alternatives to PP (25). Unfortunately, there remains no proven pharmacologic therapy in the treatment of ARDS, but research in this area is ongoing.…”