Severity of Hypoxemia may Explain Indeterminate Results in Pediatric Trials of iNO

link.springer.com June 3, 2021

Inhaled nitric oxide (iNO) is used for refractory hypoxemia in acute respiratory distress syndrome (ARDS) via vasodilation of pulmonary arterioles to ventilated alveoli, particularly in pediatrics. However, iNO has not affected mortality in pediatric or adult trials.

A criticism of these trials has been broad eligibility criteria, including subjects with mild hypoxemia.

If the efficacy of iNO is via improved hypoxemia, we reasoned that baseline oxygenation might modify the relationship between iNO and mortality.

Therefore, we tested whether pediatric ARDS hypoxemia severity modified the association between iNO and mortality in a prospective cohort of intubated ARDS from the Children’s Hospital of Philadelphia between 2011 and 2019.