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Inhaled nitric oxide: plenty of data, no consensus.

The current nitric oxide debate originated almost 20 yrs ago when Furchgott and Zawadzki (1) reported that the physiologic importance of the endothelium rested in its ability to release a diffusible vasodilator. This compound, later identified as nitric oxide, was named by Science as the "molecule of the year" in 1992 (2). Since 1992, there have been >25,000 articles published in the medical literature on nitric oxide. The rate of publication of these articles has continued to increase dramatically, with approximately one quarter of these articles published in the last 18 months. Nitric oxide has been studied in basic science laboratories, in animal physiology laboratories, in normal volunteers, and in critically ill patients. Clinical studies have been performed in neonates, children, and adults. Despite this incredible volume of data concerning all aspects of nitric oxide, no clear consensus exists regarding the appropriate clinical use of inhaled nitric oxide. This lack of consensus along with conflicting data has led clinicians to utilize inhaled nitric oxide inconsistently and without clear evidence that it is a beneficial therapy. However, this may be understandable in the acute respiratory distress syndrome (ARDS) patient population, which has high baseline mortality when using only "conventional" therapies. Inhaled nitric oxide is often viewed as a viable option in a disease that has limited proven therapeutic options.