Inhaled nitric oxide: a possible therapy for ARDS.

Ten years ago' endothelium derived relaxing factor' was identified as nitric oxide (NO.). This highly significant discovery revealed the importance of NO. in normal physiology and pathophysiology. Research over the past decade into the potential therapeutic use of inhaled NO. in the management of ARDS is reviewed. In critical care, inhaled NO. seems to produce selective pulmonary vasodilation and this is already beginning to have an impact on the management of lung injuries including ARDS. The effect of NO. in multi-system failure is not yet established. Formal evaluation in the form of clinical trials has yet to be undertaken, and further study of all the potential side effects and toxicity are required for conclusive evidence of the value of inhaled NO. in the treatment of ARDS.