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NO Linked With Increased Survival in ALI/ARDS

Researchers, in a large-scale, multi-center trial of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), showed that higher levels of// nitric oxide (NO) in patient urine were strongly associated with improved survival. It also showed more ventilator-free days, and decreased rates of organ failure in ALI/ARDS patients.

The results appear in the first issue for February 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Michael Matthay, M.D., of the University of California, San Francisco, and five associates measured NO in the urine of 566 patients enrolled in the National Heart, Lung, and Blood Institute's Acute Respiratory Distress Syndrome Network trial, which was designed to look at several different levels of respiratory support.

In humans, NO is involved in oxygen transport to the tissues, the transmission of nerve impulses and a variety of other physiological processes. A product of cellular metabolism, NO serves as a crucial physiologic messenger molecule.

ARDS is the rapid onset of respiratory failure--the inability to adequately oxygenate the blood–that often occurs in the critically ill. ALI precedes ARDS as severe respiratory illnesses progress. Both conditions can be life-threatening.

Among participants, the problems that led to ALI involved aspiration, pneumonia, sepsis (from which 25 percent suffered), and other serious medical difficulties.

The average age of the subjects was 52, with 57 percent being male and 74 percent classified as white.

By the third day of the three-day study, 62 ALI/ARDS patients had died. All of the remaining survivors had significantly higher NO levels. Lower tidal volume respiration was associated with higher levels of urine NO and fewer deaths.

The authors speculated that NO has a beneficial effect on ALI since it scavenges oxygen free radicals
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