Inhaled Nitric Oxide: A Comprehensive Pharmacological and Clinical Review

Inhaled nitric oxide (iNO) represents a pivotal therapeutic modality in contemporary neonatal and critical care medicine, functioning as a selective pulmonary vasodilator with diverse physiological implications. This comprehensive review examines the pharmacological properties, clinical applications, and therapeutic considerations surrounding iNO administration. The agent demonstrates primary efficacy in managing persistent pulmonary hypertension of newborns (PPHN) and hypoxic respiratory failure in term and near-term infants, with evolving evidence supporting select off-label applications. The mechanism of action involves guanylate cyclase activation and subsequent smooth muscle relaxation, with effects predominantly confined to the pulmonary vasculature due to rapid hemoglobin binding. Clinical administration requires precise delivery systems and vigilant monitoring to mitigate potential adverse effects, including methemoglobinemia and rebound pulmonary vasospasm. The therapeutic landscape of iNO underscores the necessity for interprofessional collaboration and evidence-based practice protocols to optimize patient outcomes while minimizing iatrogenic complications.