Abstract
Inhaled nitric oxide (INO) is a colorless, odorless gas that is also a potent pulmonary vasodilator. When given via the inhaled route it is a selective pulmonary vasodilator. INO is approved by the United States Food and Drug Administration (FDA) for the treatment of term and near-term neonates with hypoxemic respiratory failure associated with clinical or echocardiographic evidence of pulmonary arterial hypertension. A systematic review of the literature was conducted with the intention of making recommendations related to the clinical use of INO for its FDA-approved indication. Specifically, we wrote these evidence-based clinical practice guidelines to address the following questions: (1) What is the evidence for labeled use? (2) What are the specific indications for INO for neonates with acute hypoxemic respiratory failure? (3) Does the use of INO impact oxygenation, mortality, or utilization of extracorporeal membrane oxygenation (ECMO)? (4) Does INO affect long-term outcomes? (5) Is INO cost-effective therapy? (6) How is the appropriate dosing regimen and dose response to INO established? (7) How is the dose of INO titrated and weaned? (8) Which INO delivery system should be used? (9) How should INO be implemented with different respiratory support devices? (10) What adverse effects of INO should be monitored, and at what frequency? (11) What physiologic parameters should be monitored during INO? (12) Is scavenging of gases necessary to protect the caregivers? Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system, 22 recommendations are developed for the use of INO in newborns.
- inhaled nitric oxide
- mechanical ventilation
- neonate
- persistent pulmonary hypertension of the newborn
- hypoxemia
Footnotes
- Correspondence: Robert M DiBlasi RRT-NPS FAARC, Respiratory Care Department, Seattle Children's Hospital and Center for Developmental Therapeutics, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle WA 98101. E-mail: robert.diblasi{at}seattlechildrens.org.
Preparation of this clinical practice guideline was supported by the American Respiratory Care Foundation through an unrestricted grant from Ikaria. Ikaria was not involved in creating the questions, doing the literature search, writing the review, or drafting the recommendations. Full editorial control rests with the authors and the American Association for Respiratory Care Clinical Practice Guidelines Committee.
Mr DiBlasi has disclosed relationships with GE Healthcare and Monaghan Medical. Mr Myers has disclosed relationships with Cardinal and Discovery Labs. Dr Hess is an employee of the Massachusetts General Hospital, which receives royalties on patents licensed to Ikaria. He has also disclosed relationships with Philips Respironics, Covidien, Impact, Pari, and Novartis.
- Copyright © 2010 by Daedalus Enterprises Inc.
