This project is framed within the therapies for acute respiratory distress syndrome (ARDS), particularly, the efficacy of the use of inhaled nitric oxide (iNO). This syndrome has a high mortality and most of the disease management are based on mechanical ventilation. In patients with ARDS, iNO improves gas exchange and pulmonary hemodynamic but has not proven to decrease mortality nor relevant clinical outcomes. A better description of the effects of iNO on pulmonary vascular function and how this can be used for a better characterization of the response to this therapy is needed. This can also lead to a better discrimination of those patients that could benefit from the iNO treatment but the improvement in the patient monitoring during the iNO therapy is a key factor.
The impact on society of this study is based on the fact the ARDS has a high mortality and that this syndrome is very frequent in intensive care units and results as a complication of several pulmonary and non-pulmonary diseases. Complementary therapies as iNO could decrease not only mortality but also the number of days patient is under mechanical ventilation and consequently the complications related with ARDS. The high impact of this study is not only from the clinical point of view but also from an economical one because the cost for hospitals and healthcare systems. Furthermore, a better selection of patients in which iNO is used can lead to resources optimisation, decreasing the expenditures in patients with low probability of good response to this therapy.
The development of tools to improve iNo therapy and patient selection can be strategically relevant for companies working in this field and is beneficial for the entrepreneurship.
The main objective of this study was to define bedside parameters to guide and monitor pulmonary vascular function during iNO delivery in ARDS. Specific objectives are:
- To explore bedside physiologically driven parameters and monitoring tools to control iNO delivery for treating pulmonary vascular dysfunction in ARDS,
- To evaluate the pulmonary vascular effect of NO in ARDS by means of advanced imaging tools,
- To propose new algorithms based in physiologic variables for selecting patient for NO application,
- To set the most extended clinical application of iNO as a treatment for pulmonary vascular dysfunction and prevention of right ventricle failure in ARDS patients,
- To describe the dose response of iNO for the components developed to evaluate pulmonary vascular function,
- To explore new therapeutic applications of NO.
The conclusion of the study indicates it is possible to monitor parameters of the patient that represent the effect of the iNO on the patient efficiently. The results will conduct to an important improvement in patient safety for a potential use of iNO in hospital and more importantly in domiciliary condition. The results permit to optimise the use of iNO in those patients that respond properly to the treatment. Additionally, understanding better the pulmonary physiology is also key for the next set of experiments. In summary, these results are key for the design of more secure devices for also extending the application of iNO in other segment of patients.
