Inhaled Nitric Oxide for the Adult Respiratory Distress Syndrome

Rossaint, Rolf; Falke, K. J.; López, Frank A.; Slama, K.; Pison, U.; Zapol, Warren M.

doi:10.1056/nejm199302113280605

Cited by 1,685 publications

(703 citation statements)

References 37 publications

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“…More recently, injection of these agents into the corpus cavernosum has been used as a successful, temporary treatment of impotence (86). Inhaled NO gas has been administered to patients with adult respiratory distress syndromes (87) and to neonates with persistent pulmonary hypertension. This approach takes advantage of the short half-life of NO to selectively target the respiratory system.…”

Section: Therapeutic Possibilitiesmentioning

confidence: 99%

Nitric oxide and arthritis

Stefanović-Račić

Stadler

Evans

1993

Arthritis & Rheumatism

273

136

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Section: Therapeutic Possibilitiesmentioning

confidence: 99%

Nitric oxide and arthritis

Stefanović-Račić

Stadler

Evans

1993

Arthritis & Rheumatism

273

136

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“…Since the first enthusiastic report of Rossaint et aL, 13 and despite the recommendations of the AmericanEuropean ARDS consensus, 63 no study has been appropriately designed to address the clinical outcome of ARDS patients treated with inhNO. Small sample sizes, heterogeneous populations and treatments, as well as selection bias (only 5/28 studies ls,6s,7~ were dearly randomized), plagued previous studies on the effect of inhNO in ARDS patients.…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

“…Most of the authors used a unique FiNo dose, which does not optimize treatment. Finally, several studies used concomitant treatments such as ECMO,13,I4,6s,73,7s permissive hypercapnia, 7~176 or vasoactive drugs, Is,66,74,76,79,s~,s2 which make it difficult to compare outcomes. Two other multicenter randomized prospective clinical trials are under way to determine the exact role of inhNO in ARDS morbidity and mortality.…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

“…With our analysis, the global survival rate of ARDS patients with inhNO (n=256) is 54.7%, which is not different from previous studies not using inhNO. 62 Moreover, when we distinguish the pulmonary from systemic a~tiology of ARE)S, we find respective survival rates of 69.4% (n=98) and 40.2% (n=97).Since the first enthusiastic report of Rossaint et aL, 13 and despite the recommendations of the AmericanEuropean ARDS consensus, 63 no study has been appropriately designed to address the clinical outcome of ARDS patients treated with inhNO. Small sample sizes, heterogeneous populations and treatments, as well as selection bias (only 5/28 studies ls,6s,7~ were dearly randomized), plagued previous studies on the effect of inhNO in ARDS patients.…”

mentioning

confidence: 92%

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Inhaled nitric oxide: clinical applications, indications, and toxicology

1997

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Purpose: Although the analogy of nitric oxide (NO) to Endothelium-derived Relaxing Factor remains controversial, medical use of exogenous NO gas by inhalation has grown exponentially. This review presents the mechanisms of action of inhaled NO in pulmonary hypertension, hypoxaemia, inflammation and oE~iema, as well as its therapeutic and diagnostic indications wi~ emphasis on acute respiratory distress syndrome (ARDS) and toxicology, Source: Two medical databases (Current Contents, Medline) were searched for citations containing the abovementionned key words to December 1996. Moreover, many presentations in congresses such as 4th International Meeting of Biology of Nitric Oxide, 52nd and 53rd Annual Meeting of Canadian Ana~-thetists' Society or 10th Annual Meeting of European Association of Cardiothoradc Anaesthesiologists were used. Principal findings: Inhaled NO is now recognized as an invaluable tool in neonatal and paediatric critical care, and for heart/lung surgery. Other clinical applications in adults, such as chronic obstructive pulmonary disease and ARDS, require a cautious approach, The inhaled NO therapy is fairly inexpensive, but it would seem that it is not indicated for everybody with regards to the paradigm of its efficiency and potential toxicity. The recent discovery of its anti-inflammatory and extrapulmonary effects open new horizons for future applications. Conclusion: Clinical use of inhaled NO was mostly reported in case series, properly designed clinical trials must now be performed to establish its real therapeutic role. These trials would permit adequate selection of the cardiopulmonary disorders, and subsequently the patients that would maximally benefr from inhaled NO therapy.Objectif : M~me si la relation entre le monoxyde d'azote (NO) et I'EDRF (endothelium-derived relaxing factor) n'est pas 6tablie de fa~on absolue, rutilisation m~icale du NO exog~ne ,~ I'~t gazeux a cru de fa~on exponentielle. Ce survol de la litt&ature rappelle les m6canismes d'action du NO inhale dam rhypertension pulmonalre, rhypox~mie, I'inflammation et I'oed~me et jette un regard sur ses indications diagnostiques et ~rapeutiques principalement en rapport avec le syndrome de d(~tresse respirato/re de radulte (SDRA) et la toxicologie du NO. Sources : Deux bases de donn(~es (Current Contents, Medline) induant d~cembre 1996, ont ~ consult~s en faisant appel aux mots-d& mentionn& plus haut. En outre, on a n_avis~ les travaux prL, sent~ ~ des congrc~ comme le 4th International Meeting of Biolo~/ of Nitrous Oxide, les 52" et 53 e congr~s annuels de La Soci&~ canadienne des anestl~sistes et le I 0 ~ congr~s annuel de I'Assoc/at/on europ~nne des anestha_siolo~stes cardiothoraciques. Principales constatations : l'inhalation de NO est maintenant reconnue comme faisant pattie de l'arsenal th&apeutique n~natalogique, p~diatrique et chirurgical cardiopulmonaire. Chez les adultes, les autres indications comme la maladie pulmonalre obstructive chronique et le SDRA sont moins ~videntes. I'inhalation th6rapeutique de NO ne cof...

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“…13,14 Some have used the cyclic flow of the nebuliser to introduce the NO-N2 mixture at the inspiratory phase. 16 As an injector specilically designed to deliver NO was not available, we designed and built a new NO injection system.…”

mentioning

confidence: 99%

Comparison of two administration techniques of inhaled nitric oxide on nitrogen dioxide production

Dubé¹,

Francœur

Troncy

et al. 1995

Can J Anaesth

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The purpose of this study was to verify whether, compared with the introduction of the NO-N 2 mixture at the air inlet of the ventilator (classical method), a direct injection of N0-372 into the inspiratory line of the ventilator circuit with a new injection device (new method), would reduce NO2 formation by reducing contact time between 02 and NO The effect of two FrO2 (0.21 and 0.90) Accepted for publication 9th June, 1995. Nitric oxide (NO) is a vasodilator released from the guanido-terminal group of L-arginine by NO synthase, i It has a major role in cardiovascular physiology and pharmacology. 1-4 In the lung, nitric oxide opposes hypoxic vasoconstriction, 5 attenuates the response to vasoconstrictors 6 and maintains the pulmonary artery pressure low at rest and during exercise. 7 Several nitrovasodilators such as nitroglycerin and sodium nitroprusside are donors of NO, s which is the active moiety of these molecules. Nitric oxide then activates intracellular guanylate cyclase which increases the intraceUular level of eGMP. This latter substance is known for being a very potent vasoclilator. 9 Several new NO donors have been investigated, some of

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Inhaled Nitric Oxide for the Adult Respiratory Distress Syndrome

Cited by 1,685 publications

References 37 publications

Nitric oxide and arthritis

Nitric oxide and arthritis

Inhaled nitric oxide: clinical applications, indications, and toxicology

Comparison of two administration techniques of inhaled nitric oxide on nitrogen dioxide production

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