吸入一氧化氮似乎对ARDS患者没有作用
翻译：陈都 校对：肖锋

Title: There's appears to be NO role for inhaled NO in ARDS
吸入一氧化氮似乎对ARDS患者没有作用
Author 作者: John Greenwood
 
Background: The use of inhaled nitric oxide (iNO) in acute respiratory distress syndrome (ARDS) & severe hypoxemic respiratory failure has been thought to potentially improve oxygenation and clinical outcomes.  It is estimated that iNO is used in up to 14% of patients, despite a lack of evidence to show improved outcomes. 
背景：ARDS和严重低氧血症性呼吸衰竭的患者使用一氧化氮吸入被认为是可以潜在改善氧合及临床预后。尽管尚缺乏改善预后的证据，仍有近14%的患者使用一氧化氮吸入疗法。
Mechanism: Inhaled NO works as a selective pulmonary vasodilator which has been found to improve PaO2/FiO2 by 5-13%, but is costly ($1,500 - $3,000 per day) and increases risk of renal failure in the critically ill.
机制: 吸入一氧化氮可选择性扩张肺部血管，可提高5-13%的PaO2/FiO2比值，但是费用昂贵(每日1,500 - 3,000美元)并增加危重症患者肾衰风险。
Study: A recent systematic review analyzed 9 different RCTs (N=1142) and compared mortality between those with severe (PaO2/FiO2 < 100) and less severe (PaO2/FiO2 > 100) ARDS and found that iNO does not reduce mortality in patients with ARDS, regardless of the severity of hypoxemia.
研究：最近的一篇系统综述纳入了9个不同的RCT研究（n = 1142）, 文章比较了两组ARDS患者（PaO2/FiO2 < 100与PaO2/FiO2 > 100）的死亡率，结果发现不管低氧的严重程度如何，一氧化氮吸入不能降低ARDS患者死亡率。
Bottom Line: Inhaled NO is an intriguing option for the treatment of refractory hypoxemic respiratory failure, however there does not appear to be a mortality benefit to justify it's high cost and potentially negative side effects.  In the ED, it is important to focus on appropriate lung protective ventilation strategies (TV: 6-8 cc/kg IBW) and maintaining plateau pressures < 30 cm H2O in the initial stages of ARDS to prevent ventilator induced lung injury while awaiting ICU admission.
结果：对难治性的低氧呼衰，一氧化氮吸入是个有争议的选择，而且其对死亡的效果并不能抵消其价格昂贵和潜在的副作用。在急诊等待入住ICU的ARDS患者中，早期对肺通气保护策略(TV: 6-8 cc/kg IBW)的关注和保持平台压力小于< 30 cm 水柱对防止呼吸机相关肺损伤是至关重要的。
References 参考文献
Adhikari NK, Dellinger RP, Lundin S, et al. Inhaled nitric oxide does not reduce mortality in patients with acute respiratory distress syndrome regardless of severity: systematic review and meta-analysis. Crit Care Med. 2014;42(2):404-12.