Evidence map›Paper›PMID 17383982›Full record

SynthesisBMJ (Clinical research ed.)2007

Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis.

Neill K J Adhikari, Karen E A Burns, Jan O Friedrich, John T Granton, Deborah J Cook, Maureen O Meade

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 145 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
145citing papers in PubMed, 16 pooled it
29.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

145 citing papers in PubMed, 16 syntheses or guidelines pooled it, 465 citations in OpenAlex.

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  7. Prone position for acute respiratory failure in adults.The Cochrane database of systematic reviews · 2015
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  12. Guideline
  13. Acute respiratory distress syndrome.BMJ clinical evidence · 2010
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85 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Neill K J AdhikariInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. neill.adhikari@sunnybrook.ca
Karen E A Burns
Jan O Friedrich
John T Granton
Deborah J Cook
Maureen O Meade
University of Toronto · CAMcMaster University · CASunnybrook Health Science Centre · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo review the literature on the use of inhaled nitric oxide to treat acute lung injury/acute respiratory distress syndrome (ALI/ARDS) and to summarise the effects of nitric oxide, compared with placebo or usual care without nitric oxide, in adults and children with ALI or ARDS.

designSystematic review and meta-analysis. DATA SOURCES: Medline, CINAHL, Embase, and CENTRAL (to October 2006), proceedings from four conferences, and additional information from authors of 10 trials. REVIEW

methodsTwo reviewers independently selected parallel group randomised controlled trials comparing nitric oxide with control and extracted data related to study methods, clinical and physiological outcomes, and adverse events.

main outcome measuresMortality, duration of ventilation, oxygenation, pulmonary arterial pressure, adverse events.

results12 trials randomly assigning 1237 patients met inclusion criteria. Overall methodological quality was good. Using random effects models, we found no significant effect of nitric oxide on hospital mortality (risk ratio 1.10, 95% confidence interval 0.94 to 1.30), duration of ventilation, or ventilator-free days. On day one of treatment, nitric oxide increased the ratio of partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) (13%, 4% to 23%) and decreased the oxygenation index (14%, 2% to 25%). Some evidence suggested that improvements in oxygenation persisted until day four. There was no effect on mean pulmonary arterial pressure. Patients receiving nitric oxide had an increased risk of developing renal dysfunction (1.50, 1.11 to 2.02).

conclusionsNitric oxide is associated with limited improvement in oxygenation in patients with ALI or ARDS but confers no mortality benefit and may cause harm. We do not recommend its routine use in these severely ill patients.

Indexed as

Administration, InhalationAdultBronchodilator AgentsChildHumansNitric OxideOxygenPartial PressureRandomized Controlled Trials as TopicRespiratory Distress SyndromeTreatment OutcomeBronchodilator AgentsNitric OxideOxygen

Identifiers

PMID17383982
PMCPMC1852043
OpenAlexW2132222325

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.