Inhaled Nitric Oxide Does Not Reduce Mortality in Patients With Acute Respiratory Distress Syndrome Regardless of Severity: Systematic Review and Meta-Analysis*

@article{Adhikari2014InhaledNO,
  title={Inhaled Nitric Oxide Does Not Reduce Mortality in Patients With Acute Respiratory Distress Syndrome Regardless of Severity: Systematic Review and Meta-Analysis*},
  author={Neill K. J. Adhikari and Richard Phillip Dellinger and Stefan Lundin and Didier Payen and Beno{\^i}t Vallet and Herwig Gerlach and Kwang Joo Park and Sangeeta Mehta and Arthur S Slutsky and Jan O. Friedrich},
  journal={Critical Care Medicine},
  year={2014},
  volume={42},
  pages={404–412}
}
Objective:Treatment with inhaled nitric oxide improves oxygenation but not survival in mechanically ventilated patients with acute respiratory distress syndrome, but the effect may depend on the severity of hypoxemia. Our objective was to determine whether nitric oxide reduces hospital mortality in patients with severe acute respiratory distress syndrome (PaO2/FIO2 ⩽ 100 mm Hg) but not in patients with mild-moderate acute respiratory distress syndrome (100 < PaO2/FIO2 ⩽ 300 mm Hg) at the time… 
Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome: a propensity-matched cohort study
TLDR
This study showed that iNO substantially increased the risk of renal dysfunction in patients with ARDS, and older aged patients were especially susceptible to this adverse event.
Association of Response to Inhaled Nitric Oxide and Duration of Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*
  • J. Dowell, N. Thomas, N. Yehya
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2017
TLDR
Positive response to inhaled nitric oxide was associated with fewer ventilator days, without change in mortality, potentially via reduced use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation.
Role of Inhaled Nitric Oxide in the Management of Severe Acute Respiratory Distress Syndrome
TLDR
A benefit of decreased duration of mechanical ventilation and an increased rate of ECMO-free survival was demonstrated in patients who were randomized to receiving iNO, suggesting that there may be benefit to the use of iNO in pediatric ARDS (PARDS) that has not been demonstrated in adults.
Inhaled nitric oxide in adult patients with acute respiratory distress syndrome.
TLDR
The current evidence suggests that iNO should not be routinely used in patients with ARDS however, it may be considered as adjunct therapy to tentatively improve oxygenation while other therapies are being considered in patients with severely hypoxemic ARDS.
Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials
TLDR
The available data show that iNO therapy may increase the risk of renal dysfunction, especially with prolonged use and in patients with ARDS, and that future trials of iNO should evaluate renal safety.
Inhaled nitric oxide and acute kidney injury: new insights from observational data
TLDR
A retrospective cohort study evaluating the relationship between inhaled nitric oxide administered in the first 3 days of ARDS and subsequent need for renal replacement therapy (RRT) found thatNitric oxide was associated with a substantial increase in RRT, consistent with meta-analyses of trials.
Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia*
TLDR
Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival, and worsening hypoxemia was associated with initiation of rescue therapy.
Inhaled nitric oxide in patients with acute respiratory distress syndrome: an end to the debate?
TLDR
This issue of Critical Care Medicine, Adhikari et al build upon the results of a previous systematic review and meta-analysis by obtaining patient-level data to examine whether inhaled nitric oxide improves survival in patients with severe hypoxemia, a subgroup that has been underrepresented in clinical trials.
Beyond Low Tidal Volume Ventilation: Treatment Adjuncts for Severe Respiratory Failure in Acute Respiratory Distress Syndrome
TLDR
Evidence-based application of these therapies in acute respiratory distress syndrome remains a significant challenge, however, a rational stepwise approach with frequent monitoring for improvement or harm can be achieved.
Inhaled Nitric Oxide Use in Pediatric Hypoxemic Respiratory Failure*
  • J. Berger, A. Maddux, D. Wessel
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2020
TLDR
Timely clinician responsiveness to improved oxygenation with inhaled nitric oxide was associated with more ventilator-free days but not less cardiac arrests, mortality, or additional morbidity.
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References

SHOWING 1-10 OF 115 REFERENCES
Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis
TLDR
Nitric oxide is associated with limited improvement in oxygenation in patients with ALI or ARDS but confers no mortality benefit and may cause harm.
Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome and Acute Lung Injury in Adults and Children: A Systematic Review with Meta-Analysis and Trial Sequential Analysis
TLDR
iNO results in a transient improvement in oxygenation but does not reduce mortality and may be harmful, and iNO cannot be recommended for patients with acute hypoxemic respiratory failure.
Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group.
TLDR
Inhaled NO appears to be well tolerated in the population of ARDS patients studied and is associated with a significant improvement in oxygenation compared with placebo over the first 4 hrs of treatment.
Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults.
TLDR
Inhaled nitric oxide results in a transient improvement in oxygenation but does not reduce mortality and may be harmful, and cannot be recommended for patients with AHRF.
Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial.
TLDR
Inhaled nitric oxide at a dose of 5 ppm in patients with acute lung injury not due to sepsis and without evidence of nonpulmonary organ system dysfunction results in short-term oxygenation improvements but has no substantial impact on the duration of ventilatory support or mortality.
Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis
TLDR
Prone ventilation reduces mortality in patients with severe hypoxemia and should not be routine in all patients with AHRF, but may be considered for severely hypoxemic patients.
Dose-response characteristics during long-term inhalation of nitric oxide in patients with severe acute respiratory distress syndrome: a prospective, randomized, controlled study.
TLDR
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.
Healthcare costs and long-term outcomes after acute respiratory distress syndrome: A phase III trial of inhaled nitric oxide*
TLDR
ARDS, even in previously healthy adults, not only is followed by poor survival, quality of life, and function but also is associated with high costs of care and postdischarge resource use.
Association between inhaled nitric oxide treatment and long-term pulmonary function in survivors of acute respiratory distress syndrome
TLDR
ARDS patients surviving after treatment with low-dose iNO had significantly better values for select pulmonary function tests at six months post-treatment than placebo-treated patients, a factor in long-term morbidity and quality of life in this population.
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