What is the evidence for the use of pulmonary vasodilators in ARDS?

  • Most of the trials have been performed using inhaled nitric oxide
  • Overall there is no improvement in mortality
  • Transient improvement in oxygenation which may make it useful as a bridge to other therapy
    Intervention
    Population
    Conclusion

    RCT

    Dellinger et al
    Crit Care Med (1988)

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    • NO at 1.25-80 ppm vs. placebo
    • 177 patients with ARDS
    • No difference in mortality between the 2 groups
    • Short term improvement in oxygenation in NO group (>20% increase in PaO2 in first 4 hours)

    RCT

    Taylor et al
    JAMA (2004)

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    • NO at 5 ppm vs. placebo for 28 days
    • 385 patients with moderated – severe ARDS
    • No difference in mortality between the 2 groups (20% vs. 23%, p=0.54)
    • Short term improvement in oxygenation in NO group

    Meta-analysis

    Adhikari et al
    BMJ (2007)

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    • NO therapy vs. control
    • 12 RCTs including 1237 patients with ARDS
    • Use of NO is associated with:
      • No difference in mortality
      • Improved oxygenation which may persist until day 4
      • Increased risk of renal dysfunction (RR 1.50)