title: Carboxyhemoglobin formation as an unexpected side effect of inhaled nitric oxide therapy in severe acute respiratory distress syndrome.
abstract: OBJECTIVE
  To report an unexpected cause of carboxyhemoglobinemia associated with inhaled nitric oxide therapy in severe acute respiratory distress syndrome.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Medical critical care unit at Lausanne University Hospital.
  
  
  METHODS
  One female patient with acute respiratory distress syndrome treated with inhaled nitric oxide, who developed a simultaneous increase in blood methemoglobin and carboxyhemoglobin.
  
  
  CONCLUSIONS
  Potential pathophysiologic mechanisms linking acute respiratory distress syndrome, inhaled nitric oxide, methemoglobin, and carboxyhemoglobin are discussed. Since carboxyhemoglobin has a negative influence on oxygen-carrying capacity, this effect may potentially offset the beneficial influence (if any) of inhaled nitric oxide on arterial PO2. This observation does not support the use of inhaled nitric oxide in the treatment of acute respiratory distress syndrome.
authors.affiliation: Division of Critical Care, Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Rusca
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: Lucas
authors.initials: L
authors.lastname: Liaudet
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001774:Blood Chemical Analysis; D002263:Carboxyhemoglobin / Q000187:drug effects / Q000378:metabolism*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007362:Intensive Care Units; D008706:Methemoglobin / Q000187:drug effects / Q000378:metabolism*; D009569:Nitric Oxide / Q000009:adverse effects* / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D009569:Nitric Oxide; D008706:Methemoglobin; D002263:Carboxyhemoglobin