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A critical appraisal of a systematic review: Sokol J, Jacob SE, Bohn D: Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults. Cochrane Database Syst Rev 2003 (1): CD002787

Thammasitboon, Satid MD, MHPE; Thammasitboon, Supat MD

Pediatric Critical Care Medicine: May 2005 - Volume 6 - Issue 3 - p 340-343
doi: 10.1097/01.PCC.0000161284.96739.3A
Evidence-based Journal Club

Objective: To review the findings and discuss the implications of the use of inhaled nitric oxide for acute hypoxemic respiratory failure in patients beyond the neonatal period.

Design: A critical appraisal of a systematic review.

Findings: The authors conducted a systematic review with meta-analysis to determine the effect of inhaled nitric oxide on clinical outcomes of patients with acute hypoxemic respiratory failure. The outcomes included mortality, changes in oxygenation, ventilator-free days, duration of intensive care and hospital stays, and adverse effects. It was a high-quality systematic review provided with strict entry criteria, an extensive literature search, and thorough critical appraisals. Only five trials (n = 623) met entry criteria. Inhaled nitric oxide had no effect on mortality in studies without crossover of treatment failures to open-label inhaled nitric oxide (relative risk, 0.98; 95% confidence interval, 0.66–1.44). A statistically significant improvement in oxygenation was observed in one study. The effect, however, was observed only in the first 4 days of treatment and was not clinically significant. The heterogeneity in study findings precluded meta-analyses of other clinical outcomes and adverse effects in the selected studies.

Conclusions: There is insufficient evidence to determine whether inhaled nitric oxide is beneficial or harmful for acute hypoxemic respiratory failure in children and adults. While awaiting further studies to prove its benefit, inhaled nitric oxide should not either be recommended as a standard management or excluded for the treatment of acute hypoxemic respiratory failure.

From the Department of Pediatrics, Pediatric Critical Care Medicine, West Virginia University, Morgantown, WV (SaT); Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tulane University, New Orleans, LA (SuT).

Additional evidence-based journal club reviews are available on “Peds CCM:” the Pediatric Critical Care Medicine Web site:

Both authors have no financial interests to disclose.

©2005The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies