The global
COVID-19 pandemic has become the largest public health challenge of recent years. The incidence of COVID-19-related
acute hypoxemic respiratory failure (AHRF) occurs in up to 15% of hospitalized patients.
Antiviral drugs currently available to clinicians have little to no effect on mortality, length of in-
hospital stay, the need for
mechanical ventilation, or long-term effects. Inhaled
nitric oxide (iNO) administration is a promising new non-standard approach to directly treat viral burden while enhancing oxygenation. Along with its putative
antiviral affect in
COVID-19 patients, iNO can reduce inflammatory cell-mediated
lung injury by inhibiting neutrophil activation, lowering pulmonary vascular resistance and decreasing
edema in the alveolar spaces, collectively enhancing ventilation/perfusion matching. This narrative review article presents recent literature on the iNO
therapy use for
COVID-19 patients. The authors suggest that early administration of the iNO
therapy may be a safe and promising approach for the treatment of
COVID-19 patients. The authors also discuss unconventional approaches to treatment, continuous versus intermittent high-dose iNO
therapy, timing of initiation of
therapy (early versus late), and novel delivery systems. Future laboratory and clinical research is required to define the role of iNO as an adjunct
therapy against bacterial, viral, and
fungal infections.