A critical appraisal of a systematic review: Sokol J, Jacob SE, Bohn D: Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults. Cochrane Database Syst Rev 2003 (1): CD002787.
OBJECTIVE
To review the findings and discuss the implications of the use of inhaled nitric oxide for acute hypoxemic respiratory failure in patients beyond the neonatal period.


METHODS
A critical appraisal of a systematic review.


RESULTS
The authors conducted a systematic review with meta-analysis to determine the effect of inhaled nitric oxide on clinical outcomes of patients with acute hypoxemic respiratory failure. The outcomes included mortality, changes in oxygenation, ventilator-free days, duration of intensive care and hospital stays, and adverse effects. It was a high-quality systematic review provided with strict entry criteria, an extensive literature search, and thorough critical appraisals. Only five trials (n = 623) met entry criteria. Inhaled nitric oxide had no effect on mortality in studies without crossover of treatment failures to open-label inhaled nitric oxide (relative risk, 0.98; 95% confidence interval, 0.66-1.44). A statistically significant improvement in oxygenation was observed in one study. The effect, however, was observed only in the first 4 days of treatment and was not clinically significant. The heterogeneity in study findings precluded meta-analyses of other clinical outcomes and adverse effects in the selected studies.


CONCLUSIONS
There is insufficient evidence to determine whether inhaled nitric oxide is beneficial or harmful for acute hypoxemic respiratory failure in children and adults. While awaiting further studies to prove its benefit, inhaled nitric oxide should not either be recommended as a standard management or excluded for the treatment of acute hypoxemic respiratory failure.
Thammasitboon
Satid
S
Department of Pediatrics, Pediatric Critical Care Medicine, West Virginia University, Morgantown, WV, USA.
Thammasitboon
Supat
S
D000328:Adult; D002648:Child; D006801:Humans; D000208:Acute Disease; D000280:Administration, Inhalation; D002986:Clinical Trials as Topic; D000860:Hypoxia / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D007902:Length of Stay; D015201:Meta-Analysis as Topic; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000401:mortality; D012131:Respiratory Insufficiency / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D018570:Risk Assessment; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000078202:Systematic Reviews as Topic
D009569:Nitric Oxide; D014665:Vasodilator Agents