Inhalation of nitric oxide in acute lung injury: results of a European multicentre study

被引:248
作者
Lundin, S [1 ]
Mang, H
Smithies, M
Stenqvist, O
Frostell, C
机构
[1] Sahlgrens Univ Hosp, Dept Anaesthesia & Intens Care, S-41345 Gothenburg, Sweden
[2] Univ Erlangen Nurnberg, Anasthesiol Klin, D-8520 Erlangen, Germany
[3] Univ Wales Hosp, Intens Care Unit, Cardiff CF4 4XW, S Glam, Wales
[4] Karolinska Hosp, Dept Pediat Anaesthesia & Intens Care, S-10401 Stockholm, Sweden
关键词
acute respiratory failure; mechanical ventilation; nitric oxide; inhaled; pulmonary artery pressure;
D O I
10.1007/s001340050982
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine whether inhalation of nitric oxide (INO) can increase the frequency of reversal of acute lung injury (ALI) in nitric oxide (NO) responders. Design: Prospective, open, randomised, multicentre, parallel group phase III trial. Setting: General ICUs in 43 university and regional hospitals in Europe. Patients: Two hundred and sixty-eight adult patients with early ALI. Interventions: NO responders were patients whose PaO2 increased by more than 20 % when receiving 0, 2, 10 and 40 ppm of INO for 10 min within 96 h of study entry. Responders were randomly allocated to conventional treatment with or without INO. INO, 1-40 ppm, was given at the lowest effective dose for up to 30 days or until an end point was reached. The primary end point was reversal of ALI. Clinical outcome parameters and safety were assessed in all patients. Results: Two hundred and sixty eight patients were recruited, of which 180 were randomised NO responders. Frequency of reversal of ALI was no different in INO patients (61 %) and controls (54 %; p > 0.2), Development of severe respiratory failure was lower in the INO (2.2 %) than controls (10.3 %; p < 0.05). The mortality at 30 days was 44 % for INO patients, 40 % for control patients (p > 0.2 vs INO) and 45 % in non-responders. Conclusions: Improvement of oxygenation by INO did not increase the frequency of reversal of ALI. Use of inhaled NO in early ALI did not alter mortality although it did reduce the frequency of severe respiratory failure in patients developing severe hypoxaemia.
引用
收藏
页码:911 / 919
页数:9
相关论文
共 18 条
[1]   The American-European Consensus Conference on ARDS, Part 2 - Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling [J].
Artigas, A ;
Bernard, GR ;
Carlet, J ;
Dreyfuss, D ;
Gattinoni, L ;
Hudson, L ;
Lamy, M ;
Marini, JJ ;
Matthay, MA ;
Pinsky, MR ;
Spragg, R ;
Suter, PM ;
Blanch, L ;
Burchardi, H ;
Hedenstierna, C ;
Lemaire, F ;
Roussos, C ;
Mancebo, J ;
Morris, A ;
Pesenti, A ;
Rossi, A ;
Van Asbeck, BS ;
Brigham, KL ;
Dhainaut, JF ;
Fowler, AA ;
Hyers, TM ;
Morel, D ;
Rodriguez-Roisin, R ;
Schaller, MD ;
Hemmer, M ;
Torres, A ;
Villar, J ;
Vincent, JL ;
Leeper, K ;
Meyrick, B ;
Oppenheimer, L ;
Reid, L ;
Murray, JF ;
Bihari, D ;
Bosken, C ;
Goris, J ;
Johanson, WJ ;
Lanken, PN ;
Le Gall, JR ;
Morris, AH ;
Rinaldo, J ;
Pattishal, EN .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (04) :1332-1347
[2]   THE AMERICAN-EUROPEAN CONSENSUS CONFERENCE ON ARDS - DEFINITIONS, MECHANISMS, RELEVANT OUTCOMES, AND CLINICAL-TRIAL COORDINATION [J].
BERNARD, GR ;
ARTIGAS, A ;
BRIGHAM, KL ;
CARLET, J ;
FALKE, K ;
HUDSON, L ;
LAMY, M ;
LEGALL, JR ;
MORRIS, A ;
SPRAGG, R ;
COCHIN, B ;
LANKEN, PN ;
LEEPER, KV ;
MARINI, J ;
MURRAY, JF ;
OPPENHEIMER, L ;
PESENTI, A ;
REID, L ;
RINALDO, J ;
VILLAR, J ;
VANASBECK, BS ;
DHAINAUT, JF ;
MANCEBO, J ;
MATTHAY, M ;
MEYRICK, B ;
PAYEN, D ;
PERRET, C ;
FOWLER, AA ;
SCHALLER, MD ;
HUDSON, LD ;
HYERS, T ;
KNAUS, W ;
MATTHAY, R ;
PINSKY, M ;
BONE, RC ;
BOSKEN, C ;
JOHANSON, WG ;
LEWANDOWSKI, K ;
REPINE, J ;
RODRIGUEZROISIN, R ;
ROUSSOS, C ;
ANTONELLI, MA ;
BELOUCIF, S ;
BIHARI, D ;
BURCHARDI, H ;
LEMAIRE, F ;
MONTRAVERS, P ;
PETTY, TL ;
ROBOTHAM, J ;
ZAPOL, W .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (03) :818-824
[3]   PROLONGED INHALATION OF LOW CONCENTRATIONS OF NITRIC-OXIDE IN PATIENTS WITH SEVERE ADULT-RESPIRATORY-DISTRESS-SYNDROME - EFFECTS ON PULMONARY HEMODYNAMICS AND OXYGENATION [J].
BIGATELLO, LM ;
HURFORD, WE ;
KACMAREK, RM ;
ROBERTS, JD ;
ZAPOL, WM .
ANESTHESIOLOGY, 1994, 80 (04) :761-770
[4]   Use of inhaled nitric oxide in British intensive therapy units [J].
Cuthbertson, BH ;
Stott, S ;
Webster, NR .
BRITISH JOURNAL OF ANAESTHESIA, 1997, 78 (06) :696-700
[5]   Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: Results of a randomized phase II trial [J].
Dellinger, RP ;
Zimmerman, JL ;
Taylor, RW ;
Straube, RC ;
Hauser, DL ;
Criner, GJ ;
Davis, K ;
Hyers, TM ;
Papadakos, P .
CRITICAL CARE MEDICINE, 1998, 26 (01) :15-23
[6]   INHALED NITRIC-OXIDE - A SELECTIVE PULMONARY VASODILATOR REVERSING HYPOXIC PULMONARY VASOCONSTRICTION [J].
FROSTELL, C ;
FRATACCI, MD ;
WAIN, JC ;
JONES, R ;
ZAPOL, WM .
CIRCULATION, 1991, 83 (06) :2038-2047
[7]  
FROSTELL C, 1991, CIRCULATION, V84, P2212
[8]   TIME-COURSE AND DOSE-RESPONSE OF NITRIC-OXIDE INHALATION FOR SYSTEMIC OXYGENATION AND PULMONARY-HYPERTENSION IN PATIENTS WITH ADULT-RESPIRATORY-DISTRESS-SYNDROME [J].
GERLACH, H ;
ROSSAINT, R ;
PAPPERT, D ;
FALKE, KJ .
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 1993, 23 (08) :499-502
[9]   APACHE-II - A SEVERITY OF DISEASE CLASSIFICATION-SYSTEM [J].
KNAUS, WA ;
DRAPER, EA ;
WAGNER, DP ;
ZIMMERMAN, JE .
CRITICAL CARE MEDICINE, 1985, 13 (10) :818-829
[10]   Response to nitric oxide inhalation in early acute lung injury [J].
Lundin, S ;
Westfelt, UN ;
Stenqvist, O ;
Blomqvist, H ;
Lindh, A ;
Berggren, L ;
Arvidsson, S ;
Rudberg, U ;
Frostell, CG .
INTENSIVE CARE MEDICINE, 1996, 22 (08) :728-734