Nitric oxide: role in the intensive care medicine?

Abstract

This article reviews the most important issues regarding the use of inhaled nitric oxide (NO) therapy in adult acute medicine. The physiological rationale on inhaled NO property as selective pulmonary vasodilating drug suggests its use in right ventricular overload caused by pulmonary hypertension. Therefore, this property has been used to improve the ventilation/perfusion mismatch and severe arterial hypoxemia in patients with acute respiratory distress syndrome (ARDS). Four randomized control trials have been performed but none showed any benefit for the patients final outcome, thereby limiting the use of inhaled NO as a rescue therapy. Its high cost and complexity of administration have led to the search for alternative strategies. Among them, the use of phosphodiesterase type 5, the enzyme recycling the cyclic guanosine monophosphate (cGMP), the second NO messenger, seems to result in similar effects to that of inhaled NO. This review summarizes the main recommendations published by the European Society of Intensive Care Medicine (ESICM).