Evaluation of the effectiveness of nitric oxide in the treatment of acute respiratory distress syndrome in patients with severe combined trauma (a single-center prospective comparative study)

The objective was to evaluate the effectiveness of nitric oxide inhalation in correcting gas exchange disorders and clinical outcomes in patients with severe combined trauma complicated by ARDS.

Materials and methods. An open prospective study included 47 patients with ARDS against the background of severe combined trauma. Patients were divided into two groups: the 1st group (n = 24) patients who received standard therapy, the 2nd group (n = 23) patients who received, in addition to standard therapy, inhalation therapy with nitrogen monoxide at a dose of 20-28 ppm. In both groups, the parameters of artificial lung ventilation, oxygen fraction in the inhaled mixture, positive end-expiratory pressure, saturation, oxygenation index, and compliance were evaluated on days 1, 3, and 5 after the injury.

Results. In the group of patients who received inhalation therapy with nitrogen monoxide, compared to the control group, there was a decrease in ventilation parameters (PEEP and FiO₂) and an improvement in oxygenation parameters (SpO₂ and PaO₂/FiO₂) on the first day (p < 0.05). It was found that the use of inhalation therapy with nitrogen monoxide leads to a stable increase in gas exchange parameters such as the oxygenation index and arterial blood oxygen saturation on the third day after the start of therapy. The achieved improvement in gas exchange parameters was maintained on day 5 after the start of therapy. Despite a significant improvement in respiratory function, no statistically significant differences in overall mortality were observed between the groups

Conclusions. Nitric oxide inhalation therapy is an effective addition to the standard treatment of ARDS, allowing to optimize ventilation parameters and improve oxygenation in the shortest terms, thereby reducing the risk of ventilator-associated lung damage. Further research should focus on optimizing patient selection criteria and therapeutic protocols.

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