Carboxyhemoglobin formation as an unexpected side effect of inhaled nitric oxide therapy in severe acute respiratory distress syndrome.
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.
Rusca
Marco
M
Division of Critical Care, Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
Oddo
Mauro
M
Schaller
Marie-Denise
MD
Liaudet
Lucas
L
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
D009569:Nitric Oxide; D008706:Methemoglobin; D002263:Carboxyhemoglobin