Dzierba Amy L, Abel Erik E, Buckley Mitchell S, Lat Ishaq
Pharmacotherapy. 2014 Mar;34(3):279-90. doi: 10.1002/phar.1365.
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are conditions associated with an estimated mortality of 40–50%. The use of inhaled vasodilators can help to improve oxygenation without hemodynamic effects. This article reviews relevant studies addressing the safety and efficacy of inhaled nitric oxide (iNO) and aerosolized epoprostenol (aEPO) in the treatment of life-threatening hypoxemia associated with ARDS and ALI. In addition, the article also provides a practicable guide to the clinical application of these therapies. Nine prospective randomized controlled trials were included for iNO reporting on changes in oxygenation or clinical outcomes. Seven reports of aEPO were examined for changes in oxygenation. Based on currently available data, the use of either iNO or aEPO is safe to use in patients with ALI or ARDS to transiently improve oxygenation. No differences have been observed in survival, ventilator-free days, or attenuation in disease severity. Further studies with consistent end points using standard delivery devices and standard modes of mechanical ventilation are needed to determine the overall benefit with iNO or aEPO.
急性呼吸窘迫综合征（ARDS）和急性肺损伤（ALI）的估计死亡率为40%-50%。吸入血管扩张剂有助于改善氧合，且无血流动力学影响。本文综述了有关吸入一氧化氮（iNO）和气雾化依前列醇（aEPO）治疗与ARDS和ALI相关的危及生命的低氧血症的安全性和有效性的相关研究。此外，本文还为这些疗法的临床应用提供了实用指南。纳入了9项关于iNO的前瞻性随机对照试验，报告氧合或临床结局的变化。检查了7份关于aEPO的报告中氧合的变化。根据现有数据，在ALI或ARDS患者中使用iNO或aEPO来短暂改善氧合是安全的。在生存率、无呼吸机天数或疾病严重程度减轻方面未观察到差异。需要使用标准输送装置和标准机械通气模式进行具有一致终点的进一步研究，以确定iNO或aEPO的总体益处。
