{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:10:15Z","timestamp":1790079015328,"version":"4.0.1"},"reference-count":17,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator used as rescue therapy in acute respiratory distress syndrome (ARDS) for transient improvement in oxygenation. Although multiple studies demonstrate improvements in oxygenation parameters, iNO has not consistently shown a mortality benefit or reduced ventilation duration. Methods: A retrospective cohort study was conducted of mechanically ventilated adults with SARS-CoV-2 (COVID-19) admitted to a medical intensive care unit who received iNO. Demographic characteristics, comorbidities, illness severity scores, timing of iNO initiation, and clinical outcomes were analyzed, with comparisons made between survivors and non-survivors. Results: A total of 94 patients were included. The mean age was 52.0 years (Standard Deviation (SD) 14.1), 70.2% were male, and the mean body mass index was 36.5 kg\/m2 (SD 10.0). Hypertension (58.5%) and diabetes (36.2%) were the most common comorbidities. The mean Sequential Organ Failure Assessment (SOFA) score was 4.22 (SD 2.79), and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 11.69 (SD 6.98). Overall, in-hospital mortality was 85.1% (80\/94). The median time from intubation to iNO initiation was 7.6 days (mean 7.7 days). Survivors received iNO significantly earlier than non-survivors (mean 4.14 vs. 8.3 days after intubation, p = 0.024) and had a longer hospital length of stay (mean 37 vs. 23 days, p &lt; 0.01). Duration of iNO therapy did not differ between groups (p = 0.12). Conclusions: In this cohort of critically ill patients with COVID-19 and severe respiratory failure, overall mortality was extremely high. Earlier initiation of inhaled nitric oxide was associated with improved survival, whereas duration of therapy was not. These findings suggest that the timing of iNO administration may be associated with clinical outcomes and warrant further prospective investigation to confirm this association.<\/jats:p>","DOI":"10.3390\/jcm15187302","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Analysis of Inhaled Nitric Oxide and Outcomes in Mechanically Ventilated Patients with COVID-19 ARDS"],"prefix":"10.3390","volume":"15","author":[{"given":"Abbie","family":"Evans","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th St., Lubbock, TX 79430, 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Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th St., Lubbock, TX 79430, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Renee","family":"Garcia","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th St., Lubbock, TX 79430, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-4816","authenticated-orcid":false,"given":"Kenneth","family":"Nugent","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th St., Lubbock, TX 79430, 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Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1186\/s13054-024-05093-w","article-title":"Impact of Low Dose Inhaled Nitric Oxide Treatment in Spontaneously Breathing and Intubated COVID-19 Patients: A Retrospective Propensity-Matched Study","volume":"28","author":"Isha","year":"2024","journal-title":"Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alqahtani, J.S., Aldhahir, A.M., Al Ghamdi, S.S., AlBahrani, S., AlDraiwiesh, I.A., Alqarni, A.A., Latief, K., Raya, R.P., and Oyelade, T. (2022). Inhaled Nitric Oxide for Clinical Management of COVID-19: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912803"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Freidkin, L., Katz, T.G., Peles, I., Shitrit, I.B., Abayev, M., Almog, Y., Galante, O., and Fuchs, L. (2025). Medium-Term Effect of Inhaled Nitric Oxide in Mechanically Ventilated COVID-19 Patients. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030806"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13613-023-01150-9","article-title":"Inhaled Nitric Oxide in Patients With Acute Respiratory Distress Syndrome Caused by COVID-19: Treatment Modalities, Clinical Response, and Outcomes","volume":"13","author":"Papazian","year":"2023","journal-title":"Ann. Intensive Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1111\/aas.13757","article-title":"Effects of Inhaled Nitric Oxide in COVID-19-induced ARDS\u2014Is It Worthwhile?","volume":"65","author":"Lotz","year":"2021","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_7","first-page":"6422","article-title":"Inhaled Nitric Oxide as Rescue Therapy in Severe ARDS Cases Due to COVID-19 Pneumonia: A Single Center Experience","volume":"27","author":"Bicakcioglu","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Poonam, P.B., Koscik, R., Nguyen, T., Rikhi, S., and Lin, H.M. (2022). Nitric Oxide Versus Epoprostenol for Refractory Hypoxemia in Covid-19. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270646"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1164\/rccm.202304-0637OC","article-title":"High-Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure Due to COVID-19: A Multicenter Phase II Trial","volume":"208","author":"Shetty","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e440","DOI":"10.1097\/CCM.0000000000004363","article-title":"Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults With Coronavirus Disease 2019 (COVID-19)","volume":"48","author":"Alhazzani","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s001340050982","article-title":"Inhalation of nitric oxide in acute lung injury: Results of a European multicentre study","volume":"25","author":"Lundin","year":"1999","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1001\/jama.291.13.1603","article-title":"Low-Dose Inhaled Nitric Oxide in Patients With Acute Lung InjuryA Randomized Controlled Trial","volume":"291","author":"Taylor","year":"2004","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.niox.2022.05.001","article-title":"More Questions Than Answers for the Use of Inhaled Nitric Oxide in COVID-19","volume":"124","author":"Shei","year":"2022","journal-title":"Nitric Oxide"},{"key":"ref_14","first-page":"2526","article-title":"Acute Respiratory Distress Syndrome: The Berlin Definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"(2000). Acute Respiratory Distress Syndrome Network. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N. Engl. J. Med., 342, 1301\u20131308.","DOI":"10.1056\/NEJM200005043421801"},{"key":"ref_16","unstructured":"Team RC (R: A Language an Environment for Statistical Computing, 2025). R: A Language an Environment for Statistical Computing, 4.5.0."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/00000542-199909000-00027","article-title":"High-dose nitric oxide inhalation increases lung injury after gastric aspiration","volume":"91","author":"Nader","year":"1999","journal-title":"Anesthesiology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:32:51Z","timestamp":1790076771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":17,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187302"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187302","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}