INHALED NITRIC-OXIDE IN ACUTE RESPIRATORY-DISTRESS SYNDROME - A PILOTRANDOMIZED CONTROLLED-STUDY

This pilot randomized controlled clinical trial of patients with ARDS was implemented to study the impact of inhaled nitric oxide (inhNO) on lung function, morbidity, and mortality. Thirty patients with ARDS we re randomly allocated to usual care or usual care plus inhNO. The opti mal dose of inhNO was determined to be between 0.5 and 40 parts-per-mi llion daily. All therapeutic interventions were standardized. ARDS res ulted mainly from sepsis (25 of the 30). During the first 24 h, the hy poxia score increased greatly in patients treated with inhNO +70.4 mm Hg (+59%) versus +14.2 mm Hg (+9.3%) for the control group (p = 0.02), Venous admixture decreased from 25.7 to 15.2% in the inhNO group, and from only 19.4 to 14.9% in the control group (p = 0.05). After the fi rst day of therapy no further beneficial effect of inhNO was detected. Forty percent of the patients treated with inhNO were alive and weane d from mechanical ventilation within 30 d after randomization compared with 33.3% in the control group (p = 0.83). The 30-d mortality rate w as similar in the two groups; most deaths (11 of 17) were due to multi ple organ dysfunction syndrome. This study shows that inhNO, in this p opulation, may improve gas exchange but does not affect mortality.