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Nitric oxide is a colorless, highly reactive free radical gas with the chemical formula NO. It acts as a potent vasodilator by relaxing vascular smooth muscle through activation of soluble guanylate cyclase in target cells. This leads to increased levels of cyclic GMP and subsequent smooth muscle relaxation. Nitric oxide is produced endogenously in the body from L-arginine via nitric oxide synthase and plays critical roles as a signaling molecule in the cardiovascular, nervous, and immune systems. As an inhaled pharmaceutical agent (iNO), it is primarily used to treat hypoxic respiratory failure associated with pulmonary hypertension in neonates by improving oxygenation and reducing the need for extracorporeal membrane oxygenation (ECMO). It has also been used off-label for acute respiratory distress syndrome (ARDS) and other conditions involving pulmonary vasoconstriction[3][8][10].
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