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Bench-to-bedside review: Inhaled nitric oxide therapy in adults

Benedict C Creagh-Brown, Mark JD Griffiths and Timothy W Evans*

Author Affiliations

Unit of Critical Care, Faculty of Medicine, Imperial College, London, UK and Adult Intensive Care Unit, Royal Brompton Hospital, Sydney Street, London, SW6 NP, UK

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Critical Care 2009, 13:221 doi:10.1186/cc7734

Published: 29 May 2009

Abstract

Nitric oxide (NO) is an endogenous mediator of vascular tone and host defence. Inhaled nitric oxide (iNO) results in preferential pulmonary vasodilatation and lowers pulmonary vascular resistance. The route of administration delivers NO selectively to ventilated lung units so that its effect augments that of hypoxic pulmonary vasoconstriction and improves oxygenation. This 'Bench-to-bedside' review focuses on the mechanisms of action of iNO and its clinical applications, with emphasis on acute lung injury and the acute respiratory distress syndrome. Developments in our understanding of the cellular and molecular actions of NO may help to explain the hitherto disappointing results of randomised controlled trials of iNO.