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document
Dose-response characteristics during long-term inhalation of nitric oxide in patients with severe acute respiratory distress syndrome : a prospective , randomized , controlled study . Inhaled nitric oxide ( NO ) improves systemic oxygenation ( PaO2/FIO2 ) in adult patients with acute respiratory distress syndrome ( ARDS ) . However , individual response varies , and previous trials demonstrated no outcome benefit . This prospective , randomized study in 40 ARDS patients analyzed dose-response ( DR ) characteristics during long-term inhaled NO . Patients were randomized for conventional therapy ( control ) or continuous treatment with 10 parts per million ( ppm ) inhaled NO until weaning was initiated . We measured DR curves of PaO2/FIO2 versus the inhaled NO dose at regular intervals . Before treatment ( Day 0 ) , peak improvement in PaO2/FIO2 was achieved at 10 ppm for both control and NO-treated patients . After 4 days , the DR curve of the NO-treated patients was left shifted with a peak response at 1 ppm . At higher doses ( 10 and 100 ppm ) , oxygenation deteriorated , and the response to inhaled NO disappeared in several patients . This effect was not observed in the control group . There was no effect of inhaled NO on duration of mechanical ventilation or stay at the intensive care unit . In conclusion , long-term inhaled NO with constant doses of 10 ppm leads to enhanced sensitivity after several days and does do not allow reduction of ventilation parameters . Hence , previous trials on therapy with inhaled NO in ARDS should be carefully interpreted , as they used constant NO concentrations , which may have become overdoses leading to deterioration of oxygenation after several days .
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Intervention_Pharmacological
nitric oxide
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Intervention_Pharmacological
nitric oxide ( NO )
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Intervention_Pharmacological
NO
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Intervention_Control
conventional therapy ( control )
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Intervention_Pharmacological
continuous treatment with 10 parts per million ( ppm ) inhaled NO
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Intervention_Pharmacological
NO
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Intervention_Pharmacological
NO-treated
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Intervention_Pharmacological
NO-treated
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Outcome_Physical
dose-response ( DR ) characteristics
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Outcome_Other
DR curves of PaO2/FIO2 versus the inhaled NO dose
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Outcome_Other
PaO2/FIO2
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Outcome_Other
DR curve of the NO-treated patients
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Outcome_Physical
oxygenation deteriorated
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Outcome_Other
mechanical ventilation or stay at the intensive care unit
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Outcome_Physical
oxygenation
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Participant_Condition
severe acute respiratory distress syndrome
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Participant_Age
adult
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Participant_Condition
acute respiratory distress syndrome ( ARDS )
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Participant_Sample-size
40
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Participant_Condition
ARDS