Papadimos Thomas J
Department of Anesthesiology, University of Toledo, College of Medicine, 3000 Arlington Avenue, Toledo, Ohio 43614, USA.
J Trauma Manag Outcomes. 2008 Jan 14;2(1):1. doi: 10.1186/1752-2897-2-1.
The Iraq war has vividly brought the problem of traumatic brain injury to the foreground. The costs of death and morbidity in lost wages, lost taxes, and rehabilitative costs, let alone the emotional costs, are enormous. Military personnel with traumatic brain injury and acute respiratory distress syndrome may represent a substantial problem. Each of these entities, in and of itself, may cause a massive inflammatory response. Both presenting in one patient can precipitate an overwhelming physiological scenario. Inhaled nitric oxide has recently been demonstrated to have anti-inflammatory effects beyond the pulmonary system, in addition to its ability to improve arterial oxygenation. Furthermore, it is virtually without side effects, and can easily be applied to combat casualties or to civilian casualties.
Use of inhaled nitric oxide in patients with severe traumatic brain injury and acute respiratory distress syndrome will show a benefit through improved physiological parameters, a decrease in biochemical markers of inflammation and brain injury, thus leading to better outcomes.
A prospective, randomized, non-blinded clinical trial may be performed in which patients meeting the case definition could be entered into the study. The hypothesis may be confirmed by: (1) demonstrating an improvement in physiologic parameters, intracranial pressure, and brain oxygenation with inhaled nitric oxide use in severely head injured patients, and (2) demonstrating a decrease in biochemical serum markers in such patients; specifically, glial fibrillary acidic protein, inflammatory cytokines, and biomarkers of the hypothalamic-pituitary-adrenal axis, and (3) documentation of outcomes.
Inhaled nitric oxide therapy in traumatic brain injury patients with acute respiratory distress syndrome could result in increased numbers of lives saved, decreased patient morbidity, decreased hospital costs, decreased insurance carrier and government rehabilitation costs, increased tax revenue secondary to occupational rehabilitation, and families could still have their loved ones among them.
伊拉克战争使创伤性脑损伤问题凸显出来。死亡和发病造成的工资损失、税收损失以及康复费用，更不用说情感成本，数额巨大。患有创伤性脑损伤和急性呼吸窘迫综合征的军事人员可能是一个重大问题。这些病症中的每一种本身都可能引发大规模炎症反应。若在一名患者身上同时出现这两种病症，可能会引发严重的生理状况。最近有研究表明，吸入一氧化氮除了能改善动脉氧合外，还具有肺部系统以外的抗炎作用。此外，它几乎没有副作用，可轻松应用于战斗伤员或平民伤员。
在患有严重创伤性脑损伤和急性呼吸窘迫综合征的患者中使用吸入一氧化氮，将通过改善生理参数、降低炎症和脑损伤的生化标志物水平而显示出益处，从而带来更好的治疗结果。
可进行一项前瞻性、随机、非盲法的临床试验，符合病例定义的患者可纳入该研究。该假设可通过以下方式得到证实：（1）证明在重度颅脑损伤患者中使用吸入一氧化氮可改善生理参数、颅内压和脑氧合；（2）证明此类患者血清生化标志物水平降低；具体而言，包括胶质纤维酸性蛋白、炎性细胞因子以及下丘脑 - 垂体 - 肾上腺轴的生物标志物；（3）记录治疗结果。
在患有急性呼吸窘迫综合征的创伤性脑损伤患者中使用吸入一氧化氮治疗，可能会增加挽救的生命数量，降低患者发病率，减少医院费用，降低保险公司和政府的康复成本，因职业康复增加税收收入，并且家庭中仍会有他们所爱的人。
