INHALED NITRIC-OXIDE VERSUS CONVENTIONAL THERAPY - EFFECT ON OXYGENATION IN ARDS

A randomized, controlled clinical trial was performed with patients wi th acute respiratory distress syndrome (ARDS) to compare the effect of conventional therapy or inhaled nitric oxide (iNO) on oxygenation. Pa tients were randomized to either conventional therapy or conventional therapy plus iNO for 72 h. We tested the following hypotheses: (1) tha t iNO would improve oxygenation during the 72 h after randomization, a s compared with conventional therapy; and (2) that iNO would increase the likelihood that patients would improve to the extent that the Fi(O 2) could be decreased by greater than or equal to 0.15 within 72 h aft er randomization. There were two major findings. First, That iNO as co mpared with conventional therapy increased Pa-O2/Fi(O2) at 1 h, 12 h, and possibly 24 h. Beyond 24 h, the two groups had an equivalent impro vement in Pa-O2/Fi(O2). Second, that patients treated with iNO therapy were no more likely to improve so that they could be managed with a p ersistent decrease in Fi(O2) greater than or equal to 0.15 during the 72 h following randomization (11 of 20 patients with iNO versus 9 of 2 0 patients with conventional therapy, p = 0.55). In patients with seve re ARDS, our results indicate that iNO does not lead to a sustained im provement in oxygenation as compared with conventional therapy.