A Review of Inhaled Nitric Oxide and Aerosolized Epoprostenol in Acute Lung Injury or Acute Respiratory Distress Syndrome

Abstract

Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are conditions associated with an estimated mortality of 40–50%. The use of inhaled vasodilators can help to improve oxygenation without hemodynamic effects. This article reviews relevant studies addressing the safety and efficacy of inhaled nitric oxide (iNO) and aerosolized epoprostenol (aEPO) in the treatment of life-threatening hypoxemia associated with ARDS and ALI. In addition, the article also provides a practicable guide to the clinical application of these therapies. Nine prospective randomized controlled trials were included for iNO reporting on changes in oxygenation or clinical outcomes. Seven reports of aEPO were examined for changes in oxygenation. Based on currently available data, the use of either iNO or aEPO is safe to use in patients with ALI or ARDS to transiently improve oxygenation. No differences have been observed in survival, ventilator-free days, or attenuation in disease severity. Further studies with consistent end points using standard delivery devices and standard modes of mechanical ventilation are needed to determine the overall benefit with iNO or aEPO.

Noninferiority of Inhaled Epoprostenol to Inhaled Nitric Oxide for the Treatment of ARDS

“…In addition, as previously discussed, the mortality rate observed in this study was significantly higher than those reported in previous literature. 8,10,29 It is unlikely that the high mortality rate is associated with disparities in the clinical management of severe ARDS since the ventilatory parameters were consistent with those described in recent guidelines. 30 Hence, the high mortality is most likely a reflection of the severity of illness when inhaled vasodilators are considered in patients with severe ARDS.…”

Clinical and Economic Impact of Formulary Conversion From Inhaled Flolan to Inhaled Veletri for Refractory Hypoxemia in Critically Ill Patients

“…Patients who received iVEL had shorter durations of mechanical ventilation (5 [2-7] vs 9.5 [6][7][8][9][10][11][12][13][14][15][16][17][18][19] days, P < 0.001) and ICU LOSs (7 [5][6][7][8][9][10][11][12] vs 15.5 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] days, P < 0.001) compared with patients who received iFLO. There was no difference in hospital LOS or duration of inhaled epoprostenol therapy when comparing groups.…”

Cardio-Pulmonary-Renal Interactions

“…Furthermore, the role of inhaled nitric oxide for alleviation of ARDS and altering renal function has to be defined, including its anti-inflammatory properties (15). Several favorable effects are known, although trials and meta-analyses have failed to demonstrate its beneficial use in ARDS (16). Inhaled nitric oxide causes selective vasodilation of pulmonary vessels in ventilated areas without affecting systemic blood pressure and cardiac output, improves ventilationperfusion mismatch, and is a valuable option to reduce PH in susceptible patients (17).…”