title: Inhaled nitric oxide for acute chest syndrome in adult sickle cell patients: a randomized controlled study.
abstract: OBJECTIVE
  Previous clinical trials suggested that inhaled nitric oxide (iNO) could have beneficial effects in sickle cell disease (SCD) patients with acute chest syndrome (ACS).
  
  
  METHODS
  To determine whether iNO reduces treatment failure rate in adult patients with ACS, we conducted a prospective, double-blind, randomized, placebo-controlled clinical trial. iNO (80 ppm, N = 50) gas or inhaled nitrogen placebo (N = 50) was delivered for 3 days. The primary end point was the number of patients with treatment failure at day 3, defined as any one of the following: (1) death from any cause, (2) need for endotracheal intubation, (3) decrease of PaO2/FiO2 ≥ 15 mmHg between days 1 and 3, (4) augmented therapy defined as new transfusion or phlebotomy.
  
  
  RESULTS
  The two groups did not differ in age, gender, genotype, or baseline characteristics and biological parameters. iNO was well tolerated, although a transient decrease in nitric oxide concentration was mandated in one patient. There was no significant difference in the primary end point between the iNO and placebo groups [23 (46 %) and 29 (58 %); odds ratio (OR), 0.8; 95 % CI, 0.54-1.16; p = 0.23]. A post hoc analysis of the 45 patients with hypoxemia showed that those in the iNO group were less likely to experience treatment failure at day 3 [7 (33.3 %) vs 18 (72 %); OR = 0.19; 95 % CI, 0.06-0.68; p = 0.009].
  
  
  CONCLUSIONS
  iNO did not reduce the rate of treatment failure in adult SCD patients with mild to moderate ACS. Future trials should target more severely ill ACS patients with hypoxemia.
  
  
  BACKGROUND
  NCT00748423.
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France. antenne.pneumo@hmn.aphp.fr.|UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France. antenne.pneumo@hmn.aphp.fr.|Centre Hospitalier Intercommunal de Créteil, DHU A-TVB, Service de Pneumologie et Pathologie Professionnelle, Créteil, 94010, France. antenne.pneumo@hmn.aphp.fr.|Unité de Pneumologie, Service de Réanimation Médicale, CHU Henri Mondor, 51 Av Mal de Lattre de Tassigny, 94 010, Créteil Cedex, France. antenne.pneumo@hmn.aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Maitre
authors.affiliation: AP-HP, Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Pôle Thorax Voies aériennes, Unité de Réanimation Médico-chirurgicale, Paris, France.|Sorbonne Universités UPMC, Paris 06, France.
authors.forename: M
authors.initials: M
authors.lastname: Djibre
authors.affiliation: UPEC, Faculté de Médecine, Créteil, 94010, France.|AP-HP, Groupe Henri Mondor, Unité de Recherche Clinique, Créteil, 94010, France.
authors.forename: S
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: UPEC, Faculté de Médecine, Créteil, 94010, France.|AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Interne, Créteil, 94010, France.
authors.forename: A
authors.initials: A
authors.lastname: Habibi
authors.affiliation: AP-HP, Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Service de Médecine interne, Centre de Référence de la Drépanocytose Adulte, Paris, 75020, France.
authors.forename: K
authors.initials: K
authors.lastname: Stankovic Stojanovic
authors.affiliation: UPEC, Faculté de Médecine, Créteil, 94010, France.|AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Interne, Créteil, 94010, France.
authors.forename: M
authors.initials: M
authors.lastname: Khellaf
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France.|UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France.
authors.forename: I
authors.initials: I
authors.lastname: Bourgeon
authors.affiliation: Sorbonne Universités UPMC, Paris 06, France.|AP-HP, Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Service de Médecine interne, Centre de Référence de la Drépanocytose Adulte, Paris, 75020, France.
authors.forename: F
authors.initials: F
authors.lastname: Lionnet
authors.affiliation: UPEC, Faculté de Médecine, Créteil, 94010, France.|AP-HP, Groupe Henri Mondor, Unité de Recherche Clinique, Créteil, 94010, France.
authors.forename: A
authors.initials: A
authors.lastname: Charles-Nelson
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France.|Interdépartemental Division of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Brochard
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France.|UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France.
authors.forename: F
authors.initials: F
authors.lastname: Lemaire
authors.affiliation: UPEC, Faculté de Médecine, Créteil, 94010, France.|AP-HP, Groupe Henri-Mondor, Unité des Maladies du Globule Rouge, DHU A-TVB, Créteil, 94010, France.
authors.forename: F
authors.initials: F
authors.lastname: Galacteros
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France.|UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France.
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France.|AP-HP, Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Pôle Thorax Voies aériennes, Unité de Réanimation Médico-chirurgicale, Paris, France.|Sorbonne Universités UPMC, Paris 06, France.
authors.forename: M
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, 94010, France.|UPEC, Faculté de Médecine, GRC CARMAS, Créteil, 94010, France.
authors.forename: A
authors.initials: A
authors.lastname: Mekontso Dessap
mesh_terms: D056586:Acute Chest Syndrome / Q000188:drug therapy* / Q000209:etiology; D000280:Administration, Inhalation; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications; D004311:Double-Blind Method; D045462:Endothelium-Dependent Relaxing Factors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide
keywords: Acute chest syndrome; Acute lung injury; Anemia; Hemoglobinopathies; Nitric oxide; Sickle cell