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Anesth Analg 2003;97:989-998
© 2003 International Anesthesia Research Society

PEDIATRIC ANESTHESIA

Inhaled Nitric Oxide for Acute Hypoxic Respiratory Failure in Children and Adults: A Meta-analysis

Jennifer Sokol, FRACP FJFICM*,{dagger}, Susan Elizabeth Jacobs, FRACP{ddagger}, and Desmond Bohn, FRCPC*

*Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; {dagger}Department of Neonatology, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia; and {ddagger}Division of Neonatology, Royal Women’s Hospital, University of Melbourne, Melbourne, Australia

Address correspondence and reprint requests to Jennifer Sokol, FRACP, FJFICM, Department of Neonatal Intensive Care, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008 Western Australia, Australia. Address e-mail to jenni.sokol{at}health.wa.gov.au

We systematically reviewed randomized controlled trials examining inhaled nitric oxide (INO) for the treatment of acute respiratory distress syndrome or acute lung injury in children and adults. Qualitative assessments of identified trials were made, and metaanalyses were performed according to Cochrane methodology. Five randomized controlled trials (n = 535) met entry criteria. One study demonstrated significant improvement in oxygenation in the first 4 days of treatment, with no difference after this. There was no difference in ventilator-free days between treatment and placebo groups, and no specific dose of INO was more advantageous than any other. INO had no effect on mortality in trials without crossover of treatment failures to open-label INO (relative risk, 0.98; 95% confidence interval, 0.66–1.44). Other clinical indicators of effectiveness, such as duration of hospital and intensive care stay, were inconsistently reported. Lack of data prevented assessment of all outcomes. If further trials assessing INO in acute respiratory distress syndrome or acute lung injury are to proceed, they should be stratified for primary etiology, incorporate other modalities that may affect outcome, and evaluate clinically relevant outcomes before any benefit of INO can be excluded.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.