title: Rescue therapy with inhaled nitric oxide in critically ill patients with severe hypoxemic respiratory failure (Brief report).
abstract: 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.
authors.affiliation: Department of Anaesthesia, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada. barbroszel@hotmail.com
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Baxter
authors.forename: Jill
authors.initials: J
authors.lastname: Randall
authors.forename: John D
authors.initials: JD
authors.lastname: Miller
authors.forename: David A
authors.initials: DA
authors.lastname: Higgins
authors.forename: A C Peter
authors.initials: AC
authors.lastname: Powles
authors.forename: Peter T-L
authors.initials: PT
authors.lastname: Choi
mesh_terms: 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*
chemical_list: D009569:Nitric Oxide; D010100:Oxygen