Warning over nitric oxide for lung injury patients

Nitric oxide improves oxygenation but not mortality in acute lung injury: meta-analysis BMJ Online First
Use of nitric oxide in patients with acute lung injury does not improve survival and may cause harm, warn researchers in a study published on bmj.com today.

Many doctors treat acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) with inhaled nitric oxide, despite no clear supporting evidence. A review of trials in 2003 concluded that the effects of nitric oxide were uncertain.

So researchers reviewed the effects of nitric oxide, compared to placebo or usual care without nitric oxide, in adults and children with ALI or ARDS.

Twelve trials involving 1,237 patients were included. Overall quality of the trials was good. Their analysis showed no benefit of nitric oxide on mortality. Oxygenation improved after 24 hours of therapy, with limited evidence for a prolonged effect. However, patients receiving nitric oxide had an increased risk of developing renal (kidney) dysfunction.

Nitric oxide is associated with limited oxygenation improvement in patients with ALI or ARDS, but seems to have no benefit on patient survival and may cause harm, say the authors. They do not recommend its routine use in these severely ill patients.