Inhalation of nitric oxide in acute lung injury : results of a European multicentre study

Objective: To determine whether inhalation of nitric oxide (INO) can increase the frequency of reversal of acute lung injury (ALI) in nitric oxide (NO) responders. Design: Prospective, open, randomised, multicentre, parallel group phase III trial. Setting: General ICUs in 43 university and regional...

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Published in:Intensive care medicine 1999-09, Vol.25 (9), p.911-919
Main Authors: LUNDIN, S, MANG, H, SMITHIES, M, STENQVIST, O, FROSTELL, C
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Emergency and intensive respiratory care
Gases
Hospitals
Intensive care
Intensive care medicine
Medical sciences
Mortality
Nitric oxide
Pulmonary arteries
Respiratory failure
Ventilators
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Summary:Objective: To determine whether inhalation of nitric oxide (INO) can increase the frequency of reversal of acute lung injury (ALI) in nitric oxide (NO) responders. Design: Prospective, open, randomised, multicentre, parallel group phase III trial. Setting: General ICUs in 43 university and regional hospitals in Europe. Patients: Two hundred and sixty-eight adult patients with early ALI. Interventions: NO responders were patients whose PaO2 increased by more than 20 % when receiving 0, 2, 10 and 40 ppm of INO for 10 min within 96 h of study entry. Responders were randomly allocated to conventional treatment with or without INO. INO, 1-40 ppm, was given at the lowest effective dose for up to 30 days or until an end point was reached. The primary end point was reversal of ALI. Clinical outcome parameters and safety were assessed in all patients. Results: Two hundred and sixty-eight patients were recruited, of which 180 were randomised NO responders. Frequency of reversal of ALI was no different in INO patients (61 %) and controls (54 %; p > 0.2). Development of severe respiratory failure was lower in the INO (2.2 % ) than controls (10.3 %; p < 0.05). The mortality at 30 days was 44 % for INO patients, 40 % for control patients (p > 0.2 vs INO) and 45 % in non-responders. Conclusions: Improvement of oxygenation by INO did not increase the frequency of reversal of ALI. Use of inhaled NO in early ALI did not alter mortality although it did reduce the frequency of severe respiratory failure in patients developing severe hypoxaemia.[PUBLICATION ABSTRACT]
ISSN:0342-4642
1432-1238
DOI:10.1007/s001340050982