Q: 42 year old female with recent refractory hypoxemia has been salvaged with adjuvant treatment of inhaled Nitric Oxide (iNO). Patient is now improved and require discontinuation of iNO?

Answer:  Sudden discontinuation of iNO after prolonged use may cause rebound acute hypoxemia and acute pulmonary hypertension. iNO should be wean gradually. One recommended strategy is to reduce the dose by 10ppm every 2 hours till it reaches to dose of 10ppm, and then reduce the dose by 2.5ppm over several hours with close monitoring.