Monsalve-Naharro José Ángel, Domingo-Chiva Esther, García Castillo Sergio, Cuesta-Montero Pablo, Jiménez-Vizuete José María
Anesthesiology and Recovery Department. Albacete University Hospital Complex. Integrated Healthcare Management Office for Albacete. Calle Hermanos Falcó 37, Albacete..
Hospital Pharmacy Department. Albacete University Hospital Complex. Integrated Healthcare Management Office for Albacete. Calle Hermanos Falcó 37, Albacete..
Farm Hosp. 2017 Mar 1;41(2):292-312. doi: 10.7399/fh.2017.41.2.10533.
In some patients, acute respiratory distress syndrome (ARDS) leads to life-threatening refractory hypoxemia developing. Physicians may consider hypoxemic rescue therapies in an attempt to improve oxygenation in these patients while on conventional mechanical ventilation support. Use of inhaled nitric oxide (iNO) in ARDS is one of the most widely-studied pharmacological interventions over the past two decades. Its efficacy was examined in several randomized clinical trials and has undergone meta-analyses. Although iNO treatment was associated with improved oxygenation, researchers unfortunately never demonstrated a concomitant decrease in mortality or any improved outcome. Hence the current evidence suggests that iNO should not be routinely used in patients with ARDS however may be considered as adjunct therapy to tentatively improve oxygenation while other therapies are being considered in patients with severely hypoxemic ARDS.This review focuses on the therapeutic use of iNO in adult ARDS patients. We set out some recommendations for its use as rescue therapy against refractory hypoxemia.
在一些患者中，急性呼吸窘迫综合征（ARDS）会导致危及生命的难治性低氧血症。在这些患者接受传统机械通气支持时，医生可能会考虑采用低氧血症抢救疗法来改善氧合。在过去二十年中，吸入一氧化氮（iNO）在ARDS中的应用是研究最为广泛的药物干预措施之一。其疗效在多项随机临床试验中得到检验，并进行了荟萃分析。尽管iNO治疗与氧合改善相关，但遗憾的是，研究人员从未证明其能同时降低死亡率或改善任何结局。因此，目前的证据表明，iNO不应常规用于ARDS患者，但对于严重低氧血症的ARDS患者，在考虑其他治疗方法时，可将其作为辅助治疗手段，暂时改善氧合。本综述聚焦于iNO在成人ARDS患者中的治疗应用。我们针对其作为难治性低氧血症抢救疗法的使用提出了一些建议。
