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Nitric oxide: Clinical applications in critically ill patients.
Redaelli, Simone; Magliocca, Aurora; Malhotra, Rajeev; Ristagno, Giuseppe; Citerio, Giuseppe; Bellani, Giacomo; Berra, Lorenzo; Rezoagli, Emanuele.
  • Redaelli S; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Magliocca A; Department of Medical Physiopathology and Transplants, University of Milan, Milano, Italy.
  • Malhotra R; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
  • Ristagno G; Department of Medical Physiopathology and Transplants, University of Milan, Milano, Italy; Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Citerio G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Neuroscience Department, NeuroIntensive Care Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.
  • Bellani G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, ECMO Center, San Gerardo University Hospital, Monza, Italy.
  • Berra L; Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Respiratory Care Department, Massachusetts General Hospital, Boston, MA, USA.
  • Rezoagli E; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, ECMO Center, San Gerardo University Hospital, Monza, Italy. Electronic address: emanuele.rezoagli@unimib.it.
Nitric Oxide ; 121: 20-33, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1665319
ABSTRACT
Inhaled nitric oxide (iNO) acts as a selective pulmonary vasodilator and it is currently approved by the FDA for the treatment of persistent pulmonary hypertension of the newborn. iNO has been demonstrated to effectively decrease pulmonary artery pressure and improve oxygenation, while decreasing extracorporeal life support use in hypoxic newborns affected by persistent pulmonary hypertension. Also, iNO seems a safe treatment with limited side effects. Despite the promising beneficial effects of NO in the preclinical literature, there is still a lack of high quality evidence for the use of iNO in clinical settings. A variety of clinical applications have been suggested in and out of the critical care environment, aiming to use iNO in respiratory failure and pulmonary hypertension of adults or as a preventative measure of hemolysis-induced vasoconstriction, ischemia/reperfusion injury and as a potential treatment of renal failure associated with cardiopulmonary bypass. In this narrative review we aim to present a comprehensive summary of the potential use of iNO in several clinical conditions with its suggested benefits, including its recent application in the scenario of the COVID-19 pandemic. Randomized controlled trials, meta-analyses, guidelines, observational studies and case-series were reported and the main findings summarized. Furthermore, we will describe the toxicity profile of NO and discuss an innovative proposed strategy to produce iNO. Overall, iNO exhibits a wide range of potential clinical benefits, that certainly warrants further efforts with randomized clinical trials to determine specific therapeutic roles of iNO.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vasodilator Agents / Critical Illness / Hypertension, Pulmonary / Infant, Newborn, Diseases / Nitric Oxide Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Adult / Humans / Infant, Newborn Language: English Journal: Nitric Oxide Journal subject: Biochemistry / Chemistry Year: 2022 Document Type: Article Affiliation country: J.niox.2022.01.007

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vasodilator Agents / Critical Illness / Hypertension, Pulmonary / Infant, Newborn, Diseases / Nitric Oxide Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Adult / Humans / Infant, Newborn Language: English Journal: Nitric Oxide Journal subject: Biochemistry / Chemistry Year: 2022 Document Type: Article Affiliation country: J.niox.2022.01.007