Inhaled nitric oxide: Expanding indications beyond traditional boundaries.
- 1Mayo Clinic Jacksonville Campus, Jacksonville, FL.
- 2Apollo Hospitals Mumbai, Navi Mumbai, India.
Abstract
Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that improves ventilation-perfusion matching with minimal effect on systemic blood pressure. Although the FDA approval is restricted to neonatal hypoxic respiratory failure associated with pulmonary hypertension, many clinicians now use iNO in adults with conditions where elevated pulmonary vascular resistance, right ventricular dysfunction threaten stability and hypoxic respiratory failure. This review examines both the mechanistic rationale and the available evidence for such off-label use. Examples range from acute RV failure in the ICU to perioperative support in cardiac surgery, heart and lung transplantation, and severe hypoxemic respiratory failure, including COVID-19-associated acute respiratory distress syndrome (ARDS). In these settings, iNO offers rapid afterload reduction and short-term improvement in oxygenation, but randomized trials are lacking and limited studies to date have failed to consistently show outcome benefits. Adverse effects such as methemoglobinemia, nitrogen dioxide toxicity, rebound pulmonary hypertension, and a potential increase in acute kidney injury risk in certain non-cardiac surgical populations. Additionally, cost considerations and other practical limitations must be weighed carefully. Overall, current evidence supports the use of iNO as an adjunctive therapy in carefully selected critically ill patients.
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BibTeX
@article{omercikoglu2026inhaled,
title = {{Inhaled nitric oxide: Expanding indications beyond traditional boundaries.}},
author = {Elcin Omercikoglu and Prashant L Bankar and Rosa Corro and Scott A Helgeson and Sean P Kiley and Neal M Patel and Parag Patel and Maher A Baz and Pramod K Guru and Archer Martin and Hollie Saunders and Devang K Sanghavi and Pablo Moreno Franco},
journal = {JHLT open},
year = {2026},
month = sep,
doi = {10.1016/j.jhlto.2026.100697},
url = {https://europepmc.org/article/MED/42909257},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Inhaled nitric oxide: Expanding indications beyond traditional boundaries.
AU - Elcin Omercikoglu
AU - Prashant L Bankar
AU - Rosa Corro
AU - Scott A Helgeson
AU - Sean P Kiley
AU - Neal M Patel
AU - Parag Patel
AU - Maher A Baz
AU - Pramod K Guru
AU - Archer Martin
AU - Hollie Saunders
AU - Devang K Sanghavi
AU - Pablo Moreno Franco
PY - 2026
DA - 2026/09/23
JO - JHLT open
DO - 10.1016/j.jhlto.2026.100697
UR - https://europepmc.org/article/MED/42909257
AB - Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that improves ventilation-perfusion matching with minimal effect on systemic blood pressure. Although the FDA approval is restricted to neonatal hypoxic respiratory failure associated with pulmonary hypertension, many clinicians now use iNO in adults with conditions where elevated pulmonary vascular resistance, right ventricular dysfunction threaten stability and hypoxic respiratory failure. This review examines both the mechanistic rationale and the available evidence for such off-label use. Examples range from acute RV failure in the ICU to perioperative support in cardiac surgery, heart and lung transplantation, and severe hypoxemic respiratory failure, including COVID-19-associated acute respiratory distress syndrome (ARDS). In these settings, iNO offers rapid afterload reduction and short-term improvement in oxygenation, but randomized trials are lacking and limited studies to date have failed to consistently show outcome benefits. Adverse effects such as methemoglobinemia, nitrogen dioxide toxicity, rebound pulmonary hypertension, and a potential increase in acute kidney injury risk in certain non-cardiac surgical populations. Additionally, cost considerations and other practical limitations must be weighed carefully. Overall, current evidence supports the use of iNO as an adjunctive therapy in carefully selected critically ill patients.
SN - 2950-1334
ER -