Inhaled nitric oxide in 2003: a review of its mechanisms of action.
OBJECTIVE
To review the pulmonary and systemic effects of endogenous nitric oxide and inhaled nitric oxide administered to patients.


METHODS
A systematic search for experimental data, human case reports, and randomized clinical trials since 1980, the year of discovery of endothelium-derived relaxing factor.


RESULTS
Nitric oxide has pulmonary and systemic effects. Inhaled nitric oxide not only causes selective pulmonary vasodilation but also results in pulmonary vasoconstriction of the vessels perfusing non-ventilated alveolae. The systemic effects of inhaled nitric oxide, which include modulation of the distribution of systemic blood flow, increase in renal output, interaction with coagulation, fibrinolysis and platelet functions, alteration of the inflammatory response, are described and the mechanisms of nitric oxide transport are explained. The possible toxicity of inhaled nitric oxide is also discussed.


CONCLUSIONS
The multiple effects of inhaled nitric oxide support its role as a pulmonary and extra-pulmonary medication.
Wang
Tianlong
T
Department of Anesthesiology, l'Hôpital Notre-Dame du CHUM, Université de Montréal, Montréal, Québec, Canada.
El Kebir
Driss
D
Blaise
Gilbert
G
D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
D001993:Bronchodilator Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide