Nitric Oxide Brand Name– INOmax
What is Nitric Oxide
Inhaled nitric oxide is a selective pulmonary vasodilator and is supplied as a gaseous blend of nitric oxide (0.8%) and nitrogen (99.2%).
Nitric oxide is a colorless, almost odorless gas. In the environment, nitric oxide gas is considered an air pollutant and is formed from combustion (e.g., fossil fuel combustion or tobacco smoke) and lightening.
In 1987, nitric oxide was identified as a key endothelium-derived relaxing factor (EDRF). Nitric oxide has been identified as an important endogenous mediator in the cardiovascular, immune, and nervous systems.
Inhaled nitric oxide has been widely studied for its selective pulmonary vasodilation effects in adult and pediatric patients.
Inhaled nitric oxide has been studied in neonates with persistent pulmonary hypertension (PPHN) and has been shown to decrease the extent to which extracorporeal membrane oxygenation is needed for hypoxemic respiratory failure (oxygenation index more than 25).
However, up to 30% to 40% of neonates do not achieve a sustained improvement in oxygenation, and nitric oxide does not reduce mortality or length of hospitalization in newborns affected by PPHN.
Although doses up to 80 ppm have been administered in neonates, doses over 20 ppm have not been shown to be superior and increase the risk of methemoglobinemia and other complications.
In adults, inhaled nitric oxide has been studied in patients with acute lung injury and acute respiratory distress syndrome (ARDS); however, short-term improvements in oxygenation and vascular resistance associated with inhaled nitric oxide have not been documented to impact mortality.
Due to the systemic etiology of ARDS, it is unlikely that a pulmonary-selective agent such as inhaled nitric oxide will benefit overall survival.
A role for inhaled nitric oxide has been suggested in a wide variety of other disease states, including right-sided heart failure, chronic obstructive pulmonary disease, intestinal ischemia-reperfusion injury, lung transplantation, thrombotic disorders, and sickle cell disease.
The drug may help to decrease the symptoms of pulmonary fibrosis.
Indications
- acute respiratory distress syndrome (ARDS)
- altitude sickness
- chronic lung disease (CLD)
- neonatal respiratory distress syndrome
- persistent pulmonary hypertension of the newborn
- pulmonary hypertension
- sickle cell disease
Side Effects
- dizziness
- dyspnea
- headache
- hematuria
- hyperbilirubinemia
- hyperglycemia
- hypokalemia
- hypotension
- infection
- methemoglobinemia
- prolonged bleeding time
- pulmonary edema
- thrombocytopenia
- withdrawal
Monitoring Parameters
- arterial blood gases (ABGs)
- methemoglobin
- serum nitric dioxide (NO2)
- serum nitric oxide
Contraindications
- abrupt discontinuation
- accidental exposure
- breast-feeding
- coagulopathy
- heart failure
- methemoglobin reductase deficiency
- methemoglobinemia
- patent ductus arteriosus (PDA)-dependent congenital heart disease
- pregnancy
- pulmonary edema
- requires an experienced clinician
- respiratory infection
- thrombocytopenia
Interactions
No information is available regarding drug interactions associated with Nitric Oxide
