From the FDA Drug Label
The provided drug labels do not contain information about the role of nitric oxide in prehospital settings.
The FDA drug label does not answer the question.
From the Research
Nitric oxide (NO) has a crucial role in prehospital settings, primarily for treating pulmonary hypertension and hypoxemic respiratory failure, and its use is supported by recent studies such as 1. The application of inhaled nitric oxide (iNO) in prehospital care is most valuable during critical care transports for neonates with persistent pulmonary hypertension of the newborn (PPHN) and for adults with acute respiratory distress syndrome (ARDS). Key points to consider include:
- iNO is delivered at concentrations typically ranging from 5-20 parts per million (ppm), with 20 ppm being a common starting dose that can be titrated based on patient response 2.
- The medication works by selectively dilating pulmonary blood vessels in ventilated areas of the lungs, improving ventilation-perfusion matching and oxygenation without causing systemic hypotension.
- Implementation requires specialized delivery equipment, continuous monitoring of NO and nitrogen dioxide levels, and trained personnel.
- Prehospital providers should be aware that abrupt discontinuation can cause rebound pulmonary hypertension, so weaning protocols must be followed.
- The practical use of iNO in standard ambulances is limited by equipment requirements, but it remains an important tool for specialized critical care transport teams and air medical services. Recent studies, such as 1, have demonstrated the feasibility and safety of noninvasive administration of iNO in patients with acute right ventricular dysfunction, highlighting its potential benefits in prehospital settings. However, it is essential to consider the limitations and potential risks associated with iNO use, including the need for specialized equipment and trained personnel, as well as the risk of rebound pulmonary hypertension upon discontinuation 1. In prehospital settings, the use of iNO should be guided by the most recent and highest-quality evidence, such as the study by 1, which demonstrated favorable hemodynamic effects and a safety profile for noninvasive iNO administration in patients with acute right ventricular dysfunction.