Inhaled nitric oxide: way to improve oxygenation in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is an actual problem of the modern medicine. Despite current progress in management of such patients, an all-cause mortality is still very high. Mandatory approach to all ARDS patients is mechanical ventilation (MV). There are several additional ways to increase oxygenation rate in ARDS; inhaled nitric oxide (iNO) is one of them. Aims: The aim of our study was to determine a role of iNO in therapy of ARDS. Methods. We involved 30 patients with moderate to severe ARDS, PaO 2 / FiO 2 , 113.3 ± 33.7; Qs / Qt, 40.5 ± 12.9 %; APACHE II score, 20.3 ± 1.9; Lung Injury Score, 2.7 ± 0.7. iNO was administered to all patients in a starting dose of 5 ppm titrated to get positive response with PaO2 / FiO2 increase > 20 % from baseline. Results. 62 % of patients positively responded to the therapy. We observed an increase in PaO 2 / FiO 2 from 107.5 to 172.5 (p < 0.05) and a decrease in Qs / Qt from 39.3 to 27.9 (p < 0.05). Responders had statistically significantly worse oxygenation and better hemodynamics (cardiac output) parameters comparing to non-responders. iNO did not alter survival rate; patients treated with iNO had median survival time 3 days longer but this difference was not statistically significant. Conclusions. iNO is an effective way to improve oxygenation in ARDS patients. Better response was seen in patients with severe ARDS and stable central hemodynamics.