Description

Inhaled Nitric Oxide (iNO) is commonly used in the UK in the treatment of Acute Respiratory Distress Syndrome (ARDS) despite it being unlicensed. It enhances oxygenation by local improvement in V/Q mismatch and shunt, and decreases pulmonary vascular resistance lessening pulmonary oedema formation. Inhaled NO may reduce the importance of ventilator related trauma and oxygen toxicity by decreasing the need for high inspired pressures and oxygen concentration; it may also have protective effects on inflammatory processes. The short-term responses (less than 24 hours) to iNO are well documented, but there is concern about whether these benefits extend into the long term and ultimately translate into improved morbidity and mortality. It has been suggested that the benefit from early improvement in oxygenation must be balanced against the issues related to administration of iNO such as the cost and the potential toxicity. It has also been suggested that the transient improvement in oxygenation is little more than ‘cosmetic’ therapy with no real value.