Inhaled Nitric Oxide May Harm Patients With ARDS
Inhaled Nitric Oxide May Harm Patients With ARDSNEW YORK (Reuters Health) Mar 23 - Routine administration of nitric oxide to patients with acute lung injury and acute respiratory distress syndrome does not improve survival and may cause renal dysfunction, a Canadian research team reports.
Lead author Dr. Neill K. J. Adhikari, at the University of Toronto, and his colleagues explain that nitric oxide is a selective pulmonary vasodilator with anti-inflammatory properties. Some clinicians use it to improve oxygenation in severely ill patients, "despite no clear supporting evidence and several discouraging reviews and editorials," Dr. Adhikari's group notes.
In 2003, investigators who conducted a meta-analysis including five trials concluded "the effects of nitric oxide on morbidity and mortality were uncertain."
Dr. Adhikari's group conducted a second review that included 12 randomized controlled trials that compared nitric oxide with control conditions. Included were 1237 patients (135 children, but neonates). Nitric oxide was administered for a median of 6.5 days.
The results, reported March 23rd in BMJ Online First, showed that nitric oxide improved oxygenation for 24 hours and perhaps longer. But meta-analysis revealed that nitric oxide had no significant effect on mortality, duration of ventilation, ventilator-free days or pulmonary arterial pressure.
The authors also detected a trend toward increased mortality in the groups treated with nitric oxide (risk ratio 1.10), which was "highly consistent across trials, with no trial dominating the meta-analysis."
There was a significantly increased incidence of renal dysfunction (risk ratio 1.50, p = 0.008), defined as new renal replacement therapy or new raised creatinine concentration.
"Given the limited physiological improvements and possible harm, we cannot recommend routine use of nitric oxide" for patients with acute lung injury and acute respiratory distress syndrome, Dr. Adhikari and his associates conclude.
BMJ Online First, 2007.
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