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Nitric Oxide for ARDS

Posted May 28 2010 4:47pm

Nitric Oxide(NO) has been investigated in a variety of settings, from bodybuilding to premature infants to asthma, as well as for diagnostic use. Among better established uses is for ARDS. Inhaled NO therapy is successful in treating ARDS because of its vasodilator properties. It reduces pulmonary artery pressure and causes vasodilation of the blood vessels that supply the ventilated regions.Inhaled NO therapy is an effective form of treatment in acute conditions, such as ARDS and PPHN; it is particularly effective in increasing oxygen saturation and decreasing pulmonary artery pressure. It also seems to be effective in chronic disorders, such as COPD and pulmonary hypertension.

There is a general consensus that it is helpful in the management of ARDS.In a large-scale, multi-center trial of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), researchers showed that higher levels of nitric oxide (NO) in patient urine were strongly associated with improved survival, more ventilator-free days, and decreased rates of organ failure.  

Committee on Fetus and Newborn, 

Use of Inhaled Nitric Oxide

Pediatrics 2000 106: 344-345

Bloch, K. D., Ichinose, F., Roberts, J. D. Jr., Zapol, W. M. (2007). Inhaled NO as a therapeutic agent. Cardiovasc Res 75: 339-348 


Calfee, C. S., Matthay, M. A. (2007). Nonventilatory Treatments for Acute Lung Injury and ARDS. Chest 131: 913-92

Ichinose, F., Roberts, J. D. Jr, Zapol, W. M. (2004). Inhaled Nitric Oxide: A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation 109: 3106-3111

Dellinger RP, Zimmerman JL, Taylor RW. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med. Jan 1998;26(1):15-23. 

Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95.

Controlled, prospective, multicenter trials that focus on whether inhaled NO significantly increases the chances of survival in patients with severe ARDS are lacking but there are many other supportive studies and reviews.

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