Acute respiratory distress syndrome nitric oxide

Wolkow PP, Janowska E, Bartus JB, Uracz W and Gryglewski RJ, Endotoxin-induced acute respiratory distress syndrome in nitric oxide-deficient rats. Eicosanoids A.tpirin and Asthma 114 273-282, 1998. 

Dellinger RP. Inhaled nitric oxide in acute lung injury and acute respiratory distress syndrome. Inability to translate physiologic benefit to clinical outcome benefit in adult clinical trials. Intensive Care Med 1999 25(9) 881-3. 

Manktelow C, Bigatello LM, Hess D, Hurford WE. Physiologic determinants of the response to inhaled nitric oxide in patients with acute respiratory distress syndrome. Anesthesiology 1997 87(2) 297-307. 

Buratti T, Joannidis M, Pechlaner C, Wiedermann CJ. Systemic hypotension on withdrawal from inhaled nitric oxide in an adult patient with acute respiratory distress syndrome. Grit Care Med 1999 27(2) 441. 

Lam C-F, van Heerden PV, Sviri S, Roberts BL, Ilett KF. 2002. The effects of inhalation of a novel nitric oxide donor, DETA/NO, in a patient with severe hypox-aemia due to acute respiratory distress syndrome. Anaesth. Intensive Care 30 472-76... 

Mehta S, MacDonald R, Hallett DC, et al. Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2003 31 383-389. 

Treatment of acute respiratory distress syndrome (ARDS) or acute lung injury may be defined as a condition involving impaired oxygenation. The nonpharmacologic therapies include mechanical ventilation. The pharmacologic therapies include the use of exogenous surfactant, corticosteroids, acetylcysteine (antioxidant), ketoconazole, nitric oxide, eicosanoids and their inhibitors, sodium nitroprus-side (vasodilator), pentoxifylline, antiendotoxin, and anticytokine therapy and antibiotics. 

Puybasset, L., Stewart, T., Rouby, J. J., Cluzel, P., Mourgeon, E., Belin, M.-F., Arthaud, M., Landault, C., and Viars, P. (1994b). Inhaled nitric oxide reverses the increase in pulmonary vascular resistance induced by permissive hypercapnia in patients with acute respiratory distress syndrome. Anesthesiology 80, 1254-1267. 

In contrast, drugs that release endogenous nitric oxide and donors of the molecule were in use long before nitric oxide was discovered and continue to be very important in clinical medicine. The cardiovascular applications of nitroprusside (Chapter 11) and the nitrates and nitrites (Chapter 12) have been discussed. The treatments of preeclampsia and of pulmonary hypertension and acute respiratory distress syndrome are currently under clinical investigation. Early results from the pulmonary disease studies appear promising, and one preparation of nitric oxide gas (INOmax) has been approved for use in neonates with hypoxic respiratory failure. 

Nitric oxide also produces vasodilation in vascular smooth muscle. As indicated earlier, hypertension may be perpetuated by a defect in the production of nitric oxide by the vascular endothelium. In follows that providing nitric oxide directly or administering precursors for nitric oxide production may help reduce vascular resistance and decrease arterial pressure in specific hypertensive syndromes.6 To date, inhaled nitric oxide has been used to treat acute pulmonary hypertension associated with respiratory distress syndrome in new-... 

Samama CM, Diai M, Fdlahi JL et al (1995) Inhibition of platdet aggregation by inhaled nitric oxide in patients with acute aduU respiratory distress syndrome Anesthesiology 83 56-65. 

Gaseous nitric oxide is a short-lived molecule that has been used in the treatment of patients with primary pulmonary hypertension and is used in subgroups of severely ill and hypoxic children with persistent pulmonary hypertension of the newborn, in preterm infants of less than 34 weeks gestation, and in adults with acute lung injury and adult respiratory distress syndrome. There are some reports of its use for intestinal ischemia, reperfusion injury, thrombotic disorders, and sickle cell crises. 

---