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. 2023 Jun 13;36(3):112–126. doi: 10.1089/jamp.2022.0058

FIG. 1.

FIG. 1.

iNO properties exerted in classic (left side) and COVID-19 (right side) ARDS. In classic ARDS, iNO exerts the following properties: (A) maintenance of patent pulmonary vessels thanks to antiplatelet properties; (B) enhancement of the V/Q match by diverting blood flow to ventilated lung units and therefore improvement of the respiratory gas exchange, thanks to selective pulmonary vasodilatory effect; (C) offloading of the right ventricle and prevention of its failure, because of pulmonary vasodilation, which determines a reduction in PAP and then a decrease of right ventricle afterload. In COVID-19 ARDS—together with the properties described in classic ARDS—iNO has the following properties: (D) replenishment of the depleted storage of endogenous NO in the presence of inflammatory induced endothelial dysfunction (i.e., eNOS dysfunction); (E) direct viricidal activity against SARS-CoV-2; (F) immune modulation and decreased lung inflammation and prevention of SARS-CoV-2-induced endothelial dysfunction thanks to anti-inflammatory properties. ARDS, acute respiratory distress syndrome; COVID-19, coronavirus disease 2019; eNOS, endothelial nitric oxide synthase; iNO, inhaled nitric oxide; PAP, pulmonary arterial pressure; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; V/Q, ventilation/perfusion.