5. Finally, “Epitaph for nitric oxide for ARDS (Crit Care Med) http://goo.gl/fb/aoQHc – vive la #FOAMed” is a post from the anonymous account @EgertonYDavisIV (although this homage account to the fictitious alter ego of the legendary Dr. William Osler seems to be associated with the Life in the Fastlane blog, the standard bearer for EM blogs Down Under and the world over). The tweet links to a great article in the PulmCCM.org blog, created by Matthew Hoffman, MD. The author analyzes a new review in the journal Critical Care Medicine, “Inhaled nitric oxide does not reduce mortality in patients with acute respiratory distress syndrome regardless of severity: systematic review and meta-analysis.” The meta-analysis aggregates data from 1,142 patients with acute respiratory distress syndrome (ARDS) and comes to some harrowing conclusions. Just as devastating as the authors’ conclusion that nitric oxide has no mortality benefit for patients with ARDS regardless of how poorly the patients’ lungs were performing at the time of administration is the association between nitric oxide and the development of renal impairment. Taken together with the cost and hassle of nitric oxide administration, this article (and its recirculation in the FOAM world) may finally put this well-intentioned, but apparently futile, modality to rest.

Jeremy Samuel Faust MD, MS, MA, is an emergency-medicine resident at Mount Sinai Hospital in New York and Elmhurst Hospital Center in Queens. He tweets about #FOAMed and classical music @jeremyfaust.