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Research Article - Acute effects of nitric oxide inhalation in ARDS: A dose finding study at steady state kinetics Hari MShankar, Trikha A, Madan R, Kaul HL Abstract Background: Inhaled Nitric oxide (INO) decreases pulmonary artery pressures and improves oxygenation in patients with ARDS. Aim: To evaluate the dose response to 1-20 parts per million (ppm) INO in ARDS, by noting changes in oxygenation, pulmonary artery systolic pressures (PASP) and to determine optimum dose. Methodology and Design: Prospective study. Setting: 10 bed general intensive care unit. Patients: 13 consecutive patients with ARDS. Interventions: INO was given between 1-20 ppm with 15 minutes at each concentration via an insufflator from a high pressure source, to the inspiratory limb of the ventilator. Study had ascending and descending phase. Results and Conclusions: The optimum dose of INO to improve oxygenation was between 3 and 10 ppm. PaO2 improvement was independent of pulmonary haemodynamic changes. The pulmonary haemodynamic changes needed higher INO initially. Once stabilized, INO could be brought down to concentrations at which maximum improvement in PaO2 occurred. The 'responders' had lesser duration of pre INO ventilation and lower PaO2/FiO2. Keywords ARDS, nitric oxide, acute effects

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