Rescue therapy with inhaled nitric oxide in critically ill patients with severe hypoxemic respiratory failure (Brief report).
OBJECTIVE
To evaluate the efficacy of inhaled nitric oxide (iNO) on oxygenation, shunt, and pulmonary vascular resistance index (PVRI) in severely hypoxemic, ventilated patients.


METHODS
In a two-period double-blind crossover design, 14 critically ill, hypoxemic, ventilated patients were randomized to receive iNO 10 ppm in 100% oxygen or no iNO in 100% oxygen for 30 min followed by a 30-min washout period and then crossed over to the other intervention. Responders to iNO then received iNO, which was increased from 5 ppm to 25 ppm in 5 ppm increments. Severity of illness scores and cardiorespiratory variables were measured.


RESULTS
Nitric oxide decreased shunt (P=0.002) and PVRI (P=0.033) and increased oxygenation (P=0.011) although the latter two were not statistically significant after adjustment for multiple comparisons. Treatment by period interactions were observed.


CONCLUSIONS
Our findings suggest that iNO improves oxygenation to a clinically significant extent in critically ill patients who are severely hypoxemic.
Baxter
Fred J
FJ
Department of Anaesthesia, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada. barbroszel@hotmail.com
Randall
Jill
J
Miller
John D
JD
Higgins
David A
DA
Powles
A C Peter
AC
Choi
Peter T-L
PT
D000280:Administration, Inhalation; D000368:Aged; D016638:Critical Illness; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy*; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000188:drug therapy*
D009569:Nitric Oxide; D010100:Oxygen