Acute lung injury in the form of the acute respiratory distress syndrome (ARDS) continues to carry a high mortality. Recently, inhaled nitric oxide (NO) has been used in ARDS patients with severe hypoxaemia. We present a retrospective analysis concerning 33 ARDS patients treated with inhaled NO during a period of four years from 1994 to 1998. Patients were young, mean 43 years, had poor oxygenation (PaO2/FiO2 index 67 mmHG) and a lung injury score above 2.5. Eighty-two percent responded immediately to NO, 9% at a later challenge and 9% were non-responders. Mortality for the whole group was 67% and to be expected considering the severity of disease. For the group of patients with ARDS as a complication of pneumonia mortality was only 40%. In one patient therapy had to be stopped due to formation of NO2 even at very low concentrations of inhaled NO. We conclude that inhaled NO is effective in improving oxygenation in patients with ARDS. The study does not allow us to conclude anything about mortality, which was probably unchanged by this novel therapy.
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