title: Multicenter randomized controlled trial of inhaled nitric oxide for pediatric acute respiratory distress syndrome.
abstract: OBJECTIVE
  To test the hypothesis that inhaled nitric oxide (iNO) would lead to improved oxygenation and a decrease in duration of mechanical ventilation in pediatric patients with acute respiratory distress syndrome.
  
  
  METHODS
  A total of 55 children with acute respiratory distress syndrome were enrolled from 9 centers. Patients were randomized to iNO or placebo and remained on the study drug until death, they were free of ventilator support, or day 28 after the initiation of therapy.
  
  
  RESULTS
  Mean baseline oxygenation indexes (OIs) were 22.0 ± 18.4 and 25.6 ± 14.9 (iNO and placebo groups, respectively, P = .27). There was a trend toward an improved OI in the iNO group compared with the placebo group at 4 hours that became significant at 12 hours. There was no difference in the OI between groups at 24 hours. Days alive and ventilator free at 28 days was greater in the iNO group, 14.2 ± 8.1 and 9.1 ± 9.5 days (iNO and placebo groups, respectively, P = .05). Although overall survival at 28 days failed to reach statistical significance, 92% (22 of 24) in the iNO group and 72% (21 of 29) in the placebo group (P = .07), the rate of extracorporeal membrane oxygenation-free survival was significantly greater in those randomized to iNO 92% (22 of 24) vs 52% (15 of 29) for those receiving placebo (P < .01).
  
  
  CONCLUSIONS
  The use of iNO was associated with a significantly reduced duration of mechanical ventilation and significantly greater rate of extracorporeal membrane oxygenation-free survival.
authors.affiliation: Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. Electronic address: rxbronic@texaschildrens.org.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Bronicki
authors.affiliation: Children's Healthcare Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: James
authors.initials: J
authors.lastname: Fortenberry
authors.affiliation: Comer Children's Hospital, University of Chicago, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Schreiber
authors.affiliation: Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Checchia
authors.affiliation: Children's Hospital of Orange County, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Nick G
authors.initials: NG
authors.lastname: Anas
mesh_terms: D000280:Administration, Inhalation; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000628:therapy; D016037:Single-Blind Method
chemical_list: D009569:Nitric Oxide