Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1372-1380

Inhaled Nitric Oxide Versus Conventional Therapy
Effect on Oxygenation in ARDS

JOHN R. MICHAEL, RICHARD G. BARTON, JEFFREY R. SAFFLE, MARY MONE, BOAZ A. MARKEWITZ, KAREN HILLIER, MARK R. ELSTAD, EDWARD J. CAMPBELL, BRETT E. TROYER, RALPH E. WHATLEY, THEODORE G. LIOU, WAYNE M. SAMUELSON, HOLLY J. CARVETH, DOUG M. HINSON, STEPHEN E. MORRIS, BYRON L. DAVIS, and RONALD W. DAY

Departments of Medicine, Surgery, and Pediatrics, University of Utah School of Medicine; Salt Lake City Veterans Administration Medical Center; Department of Respiratory Therapy, University of Utah Hospital; and Utah Supercomputing Center, University of Utah, Salt Lake City, Utah

A randomized, controlled clinical trial was performed with patients with acute respiratory distress syndrome (ARDS) to compare the effect of conventional therapy or inhaled nitric oxide (iNO) on oxygenation. Patients were randomized to either conventional therapy or conventional therapy plus iNO for 72 h. We tested the following hypotheses: (1) that iNO would improve oxygenation during the 72 h after randomization, as compared with conventional therapy; and (2) that iNO would increase the likelihood that patients would improve to the extent that the FI_O2 could be decreased by  0.15 within 72 h after randomization. There were two major findings. First, That iNO as compared with conventional therapy increased Pa_O2/FI_O2 at 1 h, 12 h, and possibly 24 h. Beyond 24 h, the two groups had an equivalent improvement in Pa_O2/FI_O2. Second, that patients treated with iNO therapy were no more likely to improve so that they could be managed with a persistent decrease in FI_O2  0.15 during the 72 h following randomization (11 of 20 patients with iNO versus 9 of 20 patients with conventional therapy, p = 0.55). In patients with severe ARDS, our results indicate that iNO does not lead to a sustained improvement in oxygenation as compared with conventional therapy.

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