Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1483-1488

Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome
A Pilot Randomized Controlled Study

ERIC TRONCY, JEAN-PAUL COLLET, STAN SHAPIRO, JEAN-GILLES GUIMOND, LOUIS BLAIR, THIERRY DUCRUET, MARTIN FRANC UR, MARC CHARBONNEAU, and GILBERT BLAISE

Department of Anesthesia, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Campus Notre Dame, and Department of Epidemiology and Biostatistics, The Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Québec, Canada

This pilot randomized controlled clinical trial of patients with ARDS was implemented to study the impact of inhaled nitric oxide (inhNO) on lung function, morbidity, and mortality. Thirty patients with ARDS were randomly allocated to usual care or usual care plus inhNO. The optimal dose of inhNO was determined to be between 0.5 and 40 parts-per-million daily. All therapeutic interventions were standardized. ARDS resulted mainly from sepsis (25 of the 30). During the first 24 h, the hypoxia score increased greatly in patients treated with inhNO +70.4 mm Hg (+59%) versus +14.2 mm Hg (+9.3%) for the control group (p = 0.02), venous admixture decreased from 25.7 to 15.2% in the inhNO group, and from only 19.4 to 14.9% in the control group (p = 0.05). After the first day of therapy no further beneficial effect of inhNO was detected. Forty percent of the patients treated with inhNO were alive and weaned from mechanical ventilation within 30 d after randomization compared with 33.3% in the control group (p = 0.83). The 30-d mortality rate was similar in the two groups; most deaths (11 of 17) were due to multiple organ dysfunction syndrome. This study shows that inhNO, in this population, may improve gas exchange but does not affect mortality.

This article has been cited by other articles:

				E. Fan, D. M. Needham, and T. E. Stewart Ventilatory Management of Acute Lung Injury and Acute Respiratory Distress Syndrome JAMA, December 14, 2005; 294(22): 2889 - 2896. [Abstract] [Full Text] [PDF]

				R. W. Taylor, J. L. Zimmerman, R. P. Dellinger, R. C. Straube, G. J. Criner, K. Davis Jr, K. M. Kelly, T. C. Smith, and R. J. Small Low-Dose Inhaled Nitric Oxide in Patients With Acute Lung Injury: A Randomized Controlled Trial JAMA, April 7, 2004; 291(13): 1603 - 1609. [Abstract] [Full Text] [PDF]

				N. Adhikari and J. T. Granton Inhaled Nitric Oxide for Acute Lung Injury: No Place for NO? JAMA, April 7, 2004; 291(13): 1629 - 1631. [Full Text] [PDF]

				J Cranshaw, M J D Griffiths, and T W Evans The pulmonary physician in critical care c 9: Non-ventilatory strategies in ARDS Thorax, September 1, 2002; 57(9): 823 - 829. [Abstract] [Full Text] [PDF]

				F. Rose, B. Guthmann, T. Tenenbaum, L. Fink, A. Ghofrani, N. Weissmann, P. Konig, L. Ermert, G. Dahlem, J. Haenze, et al. Apical, But Not Basolateral, Endotoxin Preincubation Protects Alveolar Epithelial Cells Against Hydrogen Peroxide-Induced Loss of Barrier Function: The Role of Nitric Oxide Synthesis J. Immunol., August 1, 2002; 169(3): 1474 - 1481. [Abstract] [Full Text] [PDF]

				R. T. Schermuly, A. Roehl, N. Weissmann, H. A. Ghofrani, H. Leuchte, F. Grimminger, W. Seeger, and D. Walmrath Combination of nonspecific PDE inhibitors with inhaled prostacyclin in experimental pulmonary hypertension Am J Physiol Lung Cell Mol Physiol, December 1, 2001; 281(6): L1361 - L1368. [Abstract] [Full Text] [PDF]

				A. Kornecki, H. Frndova, A. L. Coates, and S. D. Shemie 4A Randomized Trial of Prolonged Prone Positioning in Children With Acute Respiratory Failure Chest, January 1, 2001; 119(1): 211 - 218. [Abstract] [Full Text] [PDF]

				Z.-H. ZHOU, B. SUN, K. LIN, and L.-W. ZHU Prevention of Rabbit Acute Lung Injury by Surfactant, Inhaled Nitric Oxide, and Pressure Support Ventilation Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 581 - 588. [Abstract] [Full Text]

				N. D. Ferguson and J. T. Granton Inhaled nitric oxide for hypoxemic respiratory failure: Passing bad gas? Can. Med. Assoc. J., January 1, 2000; 162(1): 85 - 86. [Full Text] [PDF]

				R. T. SCHERMULY, H. A. GHOFRANI, B. ENKE, N. WEISSMANN, F. GRIMMINGER, W. SEEGER, C. SCHUDT, and D. WALMRATH Low-dose Systemic Phosphodiesterase Inhibitors Amplify the Pulmonary Vasodilatory Response to Inhaled Prostacyclin in Experimental Pulmonary Hypertension Am. J. Respir. Crit. Care Med., November 1, 1999; 160(5): 1500 - 1506. [Abstract] [Full Text]

				S. S. Gross and P. Lane Physiological reactions of nitric oxide and hemoglobin: A radical rethink PNAS, August 31, 1999; 96(18): 9967 - 9969. [Full Text] [PDF]

				C. S Hayward, R. P Kelly, and P. S Macdonald Inhaled nitric oxide in cardiology practice Cardiovasc Res, August 15, 1999; 43(3): 628 - 638. [Abstract] [Full Text] [PDF]

				B. Guery, R. Neviere, N. Viget, C. Foucher, P. Fialdes, F. Wattel, and G. Beaucaire Inhaled NO preadministration modulates local and remote ischemia-reperfusion organ injury in a rat model J Appl Physiol, July 1, 1999; 87(1): 47 - 53. [Abstract] [Full Text] [PDF]

				M. T. GLADWIN, A. N. SCHECHTER, J. H. SHELHAMER, and F. P. OGNIBENE The Acute Chest Syndrome in Sickle Cell Disease . Possible Role of Nitric Oxide in Its Pathophysiology and Treatment Am. J. Respir. Crit. Care Med., May 1, 1999; 159(5): 1368 - 1376. [Full Text] [PDF]

				L. GALLART, Q. LU, L. PUYBASSET, G. S. UMAMAHESWARA RAO, P. CORIAT, J.-J. ROUBY, and The NO Almitrine Study Group Intravenous Almitrine Combined with Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., December 1, 1998; 158(6): 1770 - 1777. [Abstract] [Full Text] [PDF]