Outcomes/Effectiveness Research

Acute respiratory distress syndrome leads to poor outcomes and high care costs, even after treatment with inhaled nitric oxide

Acute respiratory distress syndrome (ARDS) is a life-threatening condition in which lung injury or inflammation due to pneumonia, trauma, septic shock, or other causes lead to fluid buildup and restricted breathing. Even in previously healthy adults, ARDS is followed by poor survival, quality of life, and function, as well as high care costs and post-discharge resource use. According to a new study, inhaled nitric oxide at 5 ppm has no effect on these outcomes. Thus, inhaled nitric oxide should not be routinely administered to ARDS patients outside the research setting, concludes Derek C. Angus, M.D., M.P.H., of the University of Pittsburgh.

Dr. Angus and colleagues examined the impact of inhaled nitric oxide on the outcomes of 385 previously healthy adults with ARDS at 46 academic and large community hospitals in the United States. Patients were randomized to 5 ppm inhaled nitric oxide or placebo gas. About two-thirds of both groups were alive at 1 year (67.3 percent for the nitric oxide group and 68.3 for the placebo group). Hospital costs from trial enrollment to discharge were high and similar in the nitric oxide and placebo groups ($48,500 vs. $47,800). There were also no differences in length of stay or therapeutic interventions needed for both groups.

Nearly half (43 percent) of patients were discharged to another health care facility or to home with need for professional help, and 24 percent were readmitted to the hospital in 6 months, with no differences between groups. By 1 year, patient resource use had diminished, and the majority were living independently at home. Yet, survivors of both groups still reported low quality of life and poor functioning. For example, their ability to carry out activities of daily living declined by about 40 percent from before development of ARDS and remained so 1 year later. The study was supported in part by the Agency for Healthcare Research and Quality (HS11620).

See "Healthcare costs and long-term outcomes after acute respiratory distress syndrome: A phase III trial of inhaled nitric oxide," by Dr. Angus, Gilles Clermont, M.D., M.Sc., Walter T. Linde-Zwirble, and others, in the December 2006 Critical Care Medicine 34(12), pp. 2883-2890.

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