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Review Article
Drug Therapy
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Volume 353:2683-2695 December 22, 2005 Number 25
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Inhaled Nitric Oxide Therapy in Adults
Mark J.D. Griffiths, M.R.C.P., Ph.D., and Timothy W. Evans, M.D., Ph.D.

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Background and Historical Perspective

Nitric oxide was largely regarded as a toxic pollutant until 1987, when its biologic similarities to endothelium-derived relaxing factor were demonstrated.1 Subsequently, nitric oxide and endothelium-derived relaxing factor were considered a single entity, modulating vascular tone through the stimulated formation of cyclic guanosine 3',5'-monophosphate (Figure 1).2 Endogenous nitric oxide is formed from the semiessential amino acid L-arginine by one of three (neural, inducible, and endothelial) isoforms of nitric oxide synthase. The physiologic role of endogenous nitric oxide was first shown when an infusion of an inhibitor of all forms of nitric oxide synthase in healthy volunteers led to . . . [Full Text of this Article]

Chemical Reactions of Inhaled Nitric Oxide

Physiologic Effects of Inhaled Nitric Oxide on the Cardiovascular System

Direct Cytotoxicity and Effects on Inflammation

Other Effects

Administration of Inhaled Nitric Oxide to Adults

            Route, Monitoring, and Safety

            Dose–Response Relationship

Clinical Indications for Administering Inhaled Nitric Oxide to Adults

            Acute Lung Injury and the Acute Respiratory Distress Syndrome

            Targeting Pulmonary Vascular Resistance

            Lung Transplantation

            Sickle Cell Disease

Alternatives and Adjuncts to Inhaled Nitric Oxide

            Other Inhaled Vasodilators

            Adjunctive Therapies That Increase the Effectiveness of Inhaled Nitric Oxide

Conclusions and Future Directions


Source Information

From the Adult Intensive Care Unit and Intensive Care Services, Royal Brompton Hospital, and Imperial College London — both in London.

Address reprint requests to Dr. Evans at the Unit of Critical Care, Imperial College London, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom, or at t.evans@rbh.nthames.nhs.uk.


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