Inhaled nitric oxide use in neonates: Balancing what is evidence-based and what is physiologically sound

Sherlock, Laurie; Wright, Clyde J.; Kinsella, John P.; Delaney, Cassidy

doi:10.1016/j.niox.2019.12.001

Cited by 24 publications

(12 citation statements)

References 85 publications

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“…Some scholars believe that the inhalation dose of NO should not be too high and that the inhalation dose is not proportional to the efficacy. 100 ppm inhalation in the short term is a safe range, while large doses may produce a series of adverse events [ 24 ]. Some studies have shown [ 25 ] that rebound occurs after cessation of high doses of inhaled NO therapy, so it is important to follow a slow reduction in the dosage of NO when using it for treatment, and the development of methemoglobin and pulmonary oedema may occur when using it for treatment.…”

Section: Current Status Of Pah Treatment With Inhaled Formulationsmentioning

confidence: 99%

Advances in the Study of Inhaled Formulations for the Treatment of Pulmonary Arterial Hypertension

Han

Chen

et al. 2022

Applied Bionics and Biomechanics

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Pulmonary arterial hypertension (PAH) is a serious disease with reduced systemic circulation and low bioavailability associated with conventional and dosed therapy, which inhaled drugs can avoid. A mean pulmonary artery pressure (mPAP) of ≥25 mmHg ( 1 mmHg = 0.133 kPa ) at rest or ≥30 mmHg during exercise and a pulmonary capillary pressure or left atrial pressure (PLA) of ≤15 mmHg can be diagnosed with PAH. Pulmonary hypertension is classified into primary PAH and secondary PAH according to the presence or absence of principles or risk factors. The main symptoms of pulmonary hypertension include dyspnoea, syncope, weakness, chest pain, and the presence of varying degrees of peripheral oedema. It is a highly pathogenic and life-threatening disease and can lead to delays in treatment if not diagnosed in time. In the past few years, the studies related to this progressed slowly, which brought great harm to patients with PAH. Reports showed that patients diagnosed with PAH should receive routine preventative care, such as pneumococcal and influenza vaccinations. Inhalation therapy is mainly used for the treatment of respiratory diseases and is of great interest due to the concentration of the drug in the airways and lung tissues. Therefore, the present situation of pulmonary hypertension and the characteristics of inhalation preparation were reviewed in this paper to provide some related cue for the treatment of pulmonary hypertension. In the future, it is necessary to develop more treatment methods for pulmonary hypertension.

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Section: Current Status Of Pah Treatment With Inhaled Formulationsmentioning

confidence: 99%

Advances in the Study of Inhaled Formulations for the Treatment of Pulmonary Arterial Hypertension

Han

Chen

et al. 2022

Applied Bionics and Biomechanics

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“…Askie et al showed a benefit for sub‐population use with African–American neonates at high risk for developing BPD 49 . There is increasing evidence that certain populations have better responses to iNO 50–56 …”

Section: Discussionmentioning

confidence: 99%

Epidemiologic evaluation of inhaled nitric oxide use among neonates with gestational age less than 35 weeks

Peluso

Othman

Karnati

et al. 2021

Pediatric Pulmonology

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Background and Objectives The use of inhaled nitric oxide (iNO) in +late preterm and term infants with pulmonary hypertension is Food and Drug Administration (FDA) approved and has improved outcomes and survival. iNO use is not FDA approved for preterm infants and previous studies show no mortality benefit. The objectives were 1) to determine the usage of iNO among preterm neonates <35 weeks before and after the 2010 National Institutes of Health consensus statement and 2) to evaluate characteristics and outcomes among preterm neonates who received iNO. Methods This is a population‐based cross‐sectional study. Billing and procedure codes were used to determine iNO usage. Data were queried from the National Inpatient Sample from 2004 to 2016. Neonates were included if gestational age was <35 weeks. The epochs were spilt into 2004–2010 (Epoch 1) and 2011–2016 (Epoch 2). Prevalence of iNO use, mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, length of stay, mechanical ventilation, and cost of hospitalization. Results There were 4865 preterm neonates <35 weeks who received iNO. There was a significant increase in iNO use during Epoch 2 (p < 0.001). There was significantly higher use in Epoch 2 among neonates small for gestational age (SGA) 2.3% versus 7.2%, congenital heart disease (CHD) 11.1% versus 18.6%, and BPD 35.2% versus 46.8%. Mortality was significantly lower in Epoch 2 19.8% versus 22.7%. Conclusion Usage of iNO was higher after the release of the consensus statement. The increased use of iNO among preterm neonates may be targeted at specific high‐risk populations such as SGA and CHD neonates. There was lower mortality in Epoch 2; however, the cost was doubled.

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“…iNO gas is a therapy currently approved for the treatment of pulmonary hypertension in newborns and is also used as a rescue therapy in patients with ARDS [ 13 , 14 ]. Type 3 pulmonary hypertension (due to pulmonary pathology and/or hypoxia) occurs in 40–75% of patients admitted to the ICU with pneumonia, and up to 50% of patients with ARDS [ 15 ].…”

Section: Historical Benefits Of No: Ino As Selective Pulmonary Vasodi...mentioning

confidence: 99%

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

Каменщиков

Carroll

2022

Biomedicines

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The global COVID-19 pandemic has become the largest public health challenge of recent years. The incidence of COVID-19-related acute hypoxemic respiratory failure (AHRF) occurs in up to 15% of hospitalized patients. Antiviral drugs currently available to clinicians have little to no effect on mortality, length of in-hospital stay, the need for mechanical ventilation, or long-term effects. Inhaled nitric oxide (iNO) administration is a promising new non-standard approach to directly treat viral burden while enhancing oxygenation. Along with its putative antiviral affect in COVID-19 patients, iNO can reduce inflammatory cell-mediated lung injury by inhibiting neutrophil activation, lowering pulmonary vascular resistance and decreasing edema in the alveolar spaces, collectively enhancing ventilation/perfusion matching. This narrative review article presents recent literature on the iNO therapy use for COVID-19 patients. The authors suggest that early administration of the iNO therapy may be a safe and promising approach for the treatment of COVID-19 patients. The authors also discuss unconventional approaches to treatment, continuous versus intermittent high-dose iNO therapy, timing of initiation of therapy (early versus late), and novel delivery systems. Future laboratory and clinical research is required to define the role of iNO as an adjunct therapy against bacterial, viral, and fungal infections.

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Inhaled nitric oxide use in neonates: Balancing what is evidence-based and what is physiologically sound

Cited by 24 publications

References 85 publications

Advances in the Study of Inhaled Formulations for the Treatment of Pulmonary Arterial Hypertension

Advances in the Study of Inhaled Formulations for the Treatment of Pulmonary Arterial Hypertension

Epidemiologic evaluation of inhaled nitric oxide use among neonates with gestational age less than 35 weeks

Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients

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