Inhalation of nitric oxide in the treatment of severe acute respiratory syndrome: a rescue trial in Beijing

Luni Chen, Peng Liu, He Gao, Bing Sun, Desheng Chao, Fei Wang, Yuanjue Zhu, Göran Hedenstierna, Chen G Wang, Luni Chen, Peng Liu, He Gao, Bing Sun, Desheng Chao, Fei Wang, Yuanjue Zhu, Göran Hedenstierna, Chen G Wang

Abstract

Inhalation of nitric oxide (NO) improved arterial oxygenation and enabled the reduction of inspired oxygen therapy and airway pressure support in patients with severe acute respiratory syndrome (SARS). In addition, chest radiography showed decreased spread or density of lung infiltrates, and the physiological effects remained after termination of inhaled NO therapy. These findings suggest not only a pulmonary vasodilator effect of inhaled NO, but also an effect on SARS.

Figures

Table 1
Table 1
Characteristics of patients with severe acute respiratory syndrome (SARS) who did or did not receive inhaled NO (INO) therapy.
Figure 1
Figure 1
Mean and standard deviation of oxygen saturation (SpO2), inspired oxygen fraction (FIO2), heart rate (HR), and respiratory rate (RR) before, during, and after inhaled NO (INO) treatment in the INO group and the control group. *Significant difference between the periods before and after INO treatment (P < .05, by the Wilcoxon signed rank test). #Significant difference between the INO group and the control group (P < .05).
Figure 2
Figure 2
Chest radiographs from one patient showing the progression of pneumonia (top left and right, 29 May and 2 June, respectively), the effect of 8 h of inhaled NO therapy (lower left, 4 June), and the effect after 1 week of treatment, with a decrease in the pneumonia infiltrates (lower right, 10 June). Top left, Shadows with blurred margins bilaterally and a normal heart size; top right, shadows have increased in extent and density (pleural effusion can be seen on the right side), and there is marked bulging of the pulmonary artery segment (suggestive of pulmonary hypertension) and an increased heart size; lower left, extension and density of shadows are similar to those in the radiograph from 2 June; however, the pulmonary artery segment has become flatter, indicating a reduction in pulmonary artery pressure during the inhaled NO treatment; lower right, densities are reduced bilaterally, and the heart size is almost normal.

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