iNO and organ dysfunction

Q: Prolonged use of inhaled Nitric Oxide (iNO) is intended to cause more of? - select one

A) Kidney dysfunction

B) liver dysfunction

Answer: A

Prolonged use of iNO beyond 5-7 days may increase the risk of acute kidney injury (AKI). This inference is drawn primarily from trials of its use in patients with ARDS and after cardiac surgery. 

An interesting paradox is the finding that short-term use (24 hours post-surgery) of iNO in patients who require prolonged cardiopulmonary bypass may have a protective effect for AKI. This short-term benefit is due to the fact that, in prolonged bypass cases, increased hemolysis raises plasma levels of free oxyhemoglobin, which binds and depletes endogenous NO, leading to vasoconstriction, impaired tissue perfusion, and inflammation (reference #3).

#cardiovascular

#nephrology

References:

1. Ruan SY, Huang TM, Wu HY, et al. Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials. Crit Care 2015; 19:137.

2. Gebistorf F, Karam O, Wetterslev J, Afshari A. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults. Cochrane Database Syst Rev 2016; :CD002787.

3. Lei C, Berra L, Rezoagli E, et al. Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery. Am J Respir Crit Care Med 2018; 198:1279.