Nitric oxide: some nursing implications

Trends in NO(x) abatement: a review

Implementation of stringent regulations of NO(x) emission requires the development of new technologies for NO(x) removal from exhaust gases. This article summarizes current state of NO(x) abatement strategy. Firstly, the influence of NO(x) on environment and human health is described. The main focus is put on NO(x) control methods applied in combustion of fossil fuels in power stations and mobile vehicles, as well as methods used in chemical industry. Furthermore the implementation of ozone and other oxidizing agents in NO(x) oxidation is emphasized.

Nitric oxide and nursing: a review

AIMS AND OBJECTIVES

This paper, therefore, aimed to review published literature in this area of pharmacological exploitation, to look at the therapeutic applications and clinical relevance and, by so doing, provide an accessible source for nurses to gain insight into the role of nitric oxide in the clinical setting.

BACKGROUND

Nitric oxide is a chemical mediator fundamental in the maintenance of adequate tissue perfusion and effective cardiovascular function; a major endogenous regulator of vascular tone. The use of nitrates are well established as pharmacological agents but it is only recently that it has been recognized that they act as a source of nitric oxide. Although widely addressed within the medical literature, there appears to be a paucity of nursing literature that explores either its physiological action, or its relevance to nursing practice.

CONCLUSIONS

This literature review provides an overview of the use of nitric oxide and its implications for nursing practice and patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of nitric oxide and its action is pertinent to nurses across diverse specialities. It helps in understanding the principles of many nitrogen-derived medications which nurses administer to their patients on a daily basis. In terms of oral medication, this is demonstrated by greater insights into the action of nitrates, the appreciation of surprising developments in medications such as sildenafil and the development of new drug opportunities such as nitric oxide-non-steroidal anti-inflammatory drugs. Equally, the use of inhaled nitric oxide therapy in adult and neonatal critical care units appears to be an increasingly valuable source of treatment. A particular research challenge is found in the attempt at nitric oxide inhibition in the management of septic shock. The authors argue that understanding such esoteric areas of therapeutic developments is increasingly to be part of the repertoire of knowledge and skills for nurses in the 21st century.

Inhaled nitric oxide: are the safety issues being addressed?

Interest in the therapeutic uses of Nitric Oxide (NO) has gathered pace over the last decade. It is no exaggeration for the UK Guidelines on the Use of Inhaled Nitric Oxide (Cuthbertson et al. 1997) to say that 'the use of inhaled nitric oxide in the UK has become commonplace'. The index of the third edition (1990) of TE Oh's notable Intensive Care Manual carries no reference to it. Yet, from its origins in obscure research, the discovery of NO has promised the development of therapies which might include the revolutionary transformation of approaches to the treatment of septic shock. It also holds promise in the treatment of acute respiratory distress syndrome (ARDS). It is in this context that this discussion will seek to raise fundamental questions about the health and safety aspects of this substance.