title: Beneficial effects of nitric oxide breathing in adult patients with sickle cell crisis.
abstract: Pain from vaso-occlusive crisis (VOC) is the major cause of hospitalization in patients with sickle cell disease (SCD). The beneficial therapeutic effects of inhaled nitric oxide (NO) on the pathophysiology of SCD have been reported. A double-blind, randomized, placebo-controlled clinical trial was conducted to determine whether NO breathing reduces acute VOC pain in adult patients and to study the safety of inhaled NO. Twenty-three patients experiencing acute VOC were enrolled. After randomization but before treatment, five were found to not meet final eligibility criteria. Nine patients were assigned to inhaled NO (80 ppm) and nine to placebo (21% O2). Primary outcome was the mean change in pain scores after 4 hr of inhalation, measured on a 10-cm visual analog scale (VAS). Both groups had similar baseline VAS pain scores but inhaled NO significantly reduced pain scores compared with placebo (P 5 0.02) at the end of NO inhalation. Secondary outcome was parenteral morphine use at baseline, 4, and 6 hr. Parenteral morphine use was lower in the inhaled NO group, but the difference was not statistically significant.Safety assessments included systolic blood pressure measurements,pulse oximetry readings, concentration of delivered nitrogen dioxide, and concentration of methemoglobin (metHb). None of these NO toxicities was observed.
authors.forename: C Alvin
authors.initials: CA
authors.lastname: Head
authors.forename: Paul
authors.initials: P
authors.lastname: Swerdlow
authors.forename: William A
authors.initials: WA
authors.lastname: McDade
authors.forename: Ratan Mani
authors.initials: RM
authors.lastname: Joshi
authors.forename: Tohru
authors.initials: T
authors.lastname: Ikuta
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Cooper
authors.forename: James R
authors.initials: JR
authors.lastname: Eckman
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D015815:Cell Adhesion Molecules / Q000096:biosynthesis; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D055815:Young Adult
chemical_list: D015815:Cell Adhesion Molecules; D009294:Narcotics; D009569:Nitric Oxide; D009020:Morphine