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CompletedNCT03799874Updated Jun 16, 2026Results posted

Safety and Efficacy Study of Inhaled Carbon Monoxide to Treat Acute Respiratory Distress Syndrome (ARDS)

A Phase 2 interventional study of Inhaled Carbon Monoxide at 200 ppm and Inhaled Medical air in Acute Respiratory Distress Syndrome, sponsored by Brigham and Women's Hospital. Completed at 7 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-06-16.

Sponsored by Brigham and Women's Hospital · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
4
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This study will be a multi-center, prospective, randomized, partially double-blind, placebo-controlled Phase II clinical trial of inhaled CO (iCO) for the treatment of ARDS. The trial will be conducted at 7 tertiary care medical centers including Weill Cornell Medicine/NewYork-Presbyterian Hospital, Brigham and Women's Hospital (BWH), Massachusetts General Hospital (MGH), Duke University Hospital, Durham Veterans Administration Medical Center, New York-Presbyterian Brooklyn Methodist Hospital, and Duke Regional Hospital. The purpose of this study is to evaluate the safety, tolerability, and efficacy of inhaled carbon monoxide (iCO) for the treatment of ARDS and to examine the biologic readouts of low dose iCO therapy in patients with ARDS

Read the detailed description

Acute respiratory distress syndrome (ARDS) is a devastating disease affecting military, veteran, and civilian populations. ARDS is a syndrome of severe acute lung inflammation and hypoxemic respiratory failure with an incidence of 180,000 cases annually in the United States. Despite recent advances in critical care management and lung protective ventilation strategies, ARDS morbidity and mortality remain unacceptably high. The lack of specific effective therapies for ARDS indicates a need for new treatments that target novel pathways. Carbon monoxide (CO) represents a novel therapeutic modality in ARDS based on data obtained in experimental models of ARDS over the past decade.

CO has been shown to be protective in experimental models of acute lung injury (ALI) and sepsis. Furthermore, multiple human studies have demonstrated that experimental administration of several different concentrations of CO is well tolerated and that low dose inhaled CO can be safely administered to subjects in a controlled research environment. The investigators have previously conducted a Phase I trial of low dose iCO in ARDS which demonstrated that precise administration of low dose iCO (100 and 200 ppm) is feasible, well-tolerated, and safe in patients with sepsis-induced ARDS.

The purpose of this study is to assess the safety and efficacy of low dose inhaled carbon monoxide (iCO) therapy in mechanically ventilated patients with ARDS.

02

Conditions studied

  • Acute Respiratory Distress Syndrome
03

In context

Respiratory Distress Syndrome

1,597 studies on the registry are indexed under Respiratory Distress Syndrome; 312 are open to participants now.

This study's enrollment of 4 is below the median of 60 across 961 interventional studies indexed under Respiratory Distress Syndrome.

Browse Respiratory Distress Syndrome studies →

Lead sponsor

Brigham and Women's Hospital is the lead sponsor of 1,236 studies on the registry; 224 are open to participants now.

Of its 116 completed or terminated interventional studies of FDA-regulated products, 64 (55%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

All intubated patients ≥ 18 years old with ARDS

  1. ARDS is defined when all four of the following criteria are met:

    1. A PaO2/FiO2 ratio ≤ 300 with at least 5 cm H2O positive end-expiratory airway pressure (PEEP)
    2. Bilateral opacities on frontal chest radiograph (not fully explained by effusions, lobar/lung collapse, or nodules) within 1 week of a known clinical insult or new or worsening respiratory symptoms
    3. A need for positive pressure ventilation by an endotracheal or tracheal tube
    4. Respiratory failure not fully explained by cardiac failure or fluid overload; need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present.
  2. ARDS onset is defined as the time the last of criteria 1-4 are met. ARDS must persist through the enrollment time window of 168 hours.

Exclusion criteria

Exclusion Criteria:

An individual who meets any of the following criteria will be excluded from participation in this study:

  1. Age less than 18 years
  2. Greater than 168 hours since ARDS onset
  3. Pregnant or breastfeeding
  4. Prisoner
  5. Patient, surrogate, or physician not committed to full support (exception: a patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest)
  6. No consent/inability to obtain consent or appropriate legal representative not available
  7. Physician refusal to allow enrollment in the trial
  8. Moribund patient not expected to survive 24 hours
  9. No arterial or central line/no intent to place an arterial or central line
  10. No intent/unwillingness to follow lung protective ventilation strategy
  11. Severe hypoxemia defined as SpO2 \< 95 or PaO2 \< 90 on FiO2 ≥ 0.9
  12. Hemoglobin \< 7.0 g/dL
  13. Subjects who are Jehovah's Witnesses or are otherwise unable or unwilling to receive blood transfusions during hospitalization
  14. Acute myocardial infarction (MI) or acute coronary syndrome (ACS) within the last 90 days
  15. Coronary artery bypass graft (CABG) surgery within 30 days
  16. Angina pectoris or use of nitrates with activities of daily living
  17. Cardiopulmonary disease classified as NYHA class IV
  18. Stroke (ischemic or hemorrhagic) within the prior 1 month, cardiac arrest requiring CPR within the prior 72 hours, or inability to assess mental status following cardiac arrest
  19. Burns > 40% total body surface area (TBSA)
  20. Severe airway inhalational injury
  21. Use of high frequency oscillatory ventilation
  22. Use of extracorporeal membrane oxygenation (ECMO)
  23. Concomitant use of inhaled pulmonary vasodilator therapy (eg. nitric oxide [NO] or prostaglandins)
  24. Diffuse alveolar hemorrhage from vasculitis
  25. Concurrent participation in other investigational drug study
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Care provider)
Enrollment
4 participants (actual)

Study arms

  • Experimental
    Inhaled Carbon Monoxide

    Inhaled Carbon Monoxide at 200 ppm for up to 90 minutes daily for 3 days.

    Drug: Inhaled Carbon Monoxide at 200 ppm

  • Placebo comparator
    Medical air

    Inhaled Medical Air for up to 90 minutes daily for 3 days.

    Other: Inhaled Medical air

Interventions

  • DrugInhaled Carbon Monoxide at 200 ppm

    Inhaled Carbon Monoxide at 200 ppm for 90 minutes daily for 3 days.

    Also known as: iCO

  • OtherInhaled Medical air

    Inhaled Medical Air for up to 90 minutes daily for 3 days.

06

What researchers measure

Primary outcomes

  1. Primary Safety Outcome: Number of Pre-specified Administration-related Adverse Events.

    Safety of inhaled CO, defined by the incidence of pre-specified administration-related AEs (as defined below) and spontaneously reported AEs through study day 7. 1. Acute MI within 48 hours of study drug administration 2. Acute cerebrovascular accident (CVA) within 48 hours of study drug administration 3. New onset atrial or ventricular arrhythmia requiring DC cardioversion within 48 hours of study drug administration 4. Increased oxygenation requirements defined as: an increase in FiO2 of ≥ 0.2 AND increase in PEEP ≥ 5 cm H2O within 6 hours of study drug administration 5. Increase in COHb ≥ 10% 6. Increase in lactate by ≥ 2 mmol/L within 6 hours of study drug administration

    Time frame: 7 days

  2. Primary Efficacy Outcome: Change in Mitochondrial DNA (mtDNA) Level From Day 1 to Day 5

    Mitochondrial DNA (mtDNA) plasma levels will be measured by quantitative PCR of human NADH dehydrogenase 1. The number presented is the percentage average difference from beginning to end of treatment. Limited number of measurements prevents variance analyses; therefore we present the data from the subjects available in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 5 days

Secondary outcomes

  1. Lung Injury Score (LIS) on Days 1-5, and on Days 1-7

    The Lung Injury Score (LIS) is a composite 4-point scoring system including the PaO2/FiO2, PEEP, quasi-static respiratory compliance, and the extent of infiltrates on the chest X-ray. Each of the four components is categorized from 0 to 4, where a higher number is worse. The total Lung Injury Score is obtained by dividing the aggregate sum by the number of components used. Previous randomized clinical trials in ARDS have shown that a decreased LIS correlates with improvement in lung physiology as well as important clinical outcomes including mortality and ventilator-free days (VFDs). The number presented is the average difference from beginning to end of treatment. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 7 days

  2. Percent Change in PaO2/FiO2 Ratio on Days 1-5, and on Days 1-7

    PaO2/FiO2 will be measured daily on days 1-5 and days 1-7 in ventilated subjects. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 7 days

  3. Percent Change in Oxygenation Index (OI) on Days 1-5, and Days 1-7

    The oxygenation index will be measured on days 1-5 and on days 1-7 in ventilated subjects. Oxygenation index is calculated as (FiO2 X mean airway pressure)/PaO2. We provide change in Oi from baseline. Oi is only measured when subjects are ventilated, therefore not all timepoints are available. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 7 days

  4. Percent Change in Dead Space Fraction (Vd/Vt) on Days 1-3, and Days 1-7

    The dead space fraction will be measured days 1-3 and days 1-7 in ventilated subjects. We present change in dead space fraction between initial and final measurements that were available (measurements only taken while the subjects were intubated). The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 7 days

  5. Percent Change in Sequential Organ Failure Assessment (SOFA) Score on Days 1-5, and Days 1-7.

    Organ failure will be assessed using the SOFA score. SOFA scores will be assessed daily on days 1-5 and day 7, as the SOFA score has been shown to be a reliable prognostic indicator of outcomes in critically ill patients. To calculate the Sequential Organ Failure Assessment (SOFA) score, each of the six components (Respiratory, Coagulation, Liver, Cardiovascular, Central Nervous System, Renal) is categorized from 0-4, where a higher number is worse. The SOFA score (0-24) will be calculated by summing all six components. We present changes in SOFA score over the time of hospitalization, over the time of ICU admission (up to days 5 and 7 for the enrolled subjects). The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 1-5 and 1-7 days

  6. Absolute Value of Biomarkers of Inflammation and Inflammasome Activation

    Cytokine plasma levels (eg. IL-1B) will be measured by ELISA daily on days 1-3 and on day 4. We report the absolute Mean Fluorescent Intensity (MFI) of each sample at pretreatment time point of day 4. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number" without standard deviation, since measures of dispersion cannot be calculated.

    Time frame: 4 days

  7. Percent Change in Lipid Mediators

    Lipid mediators (LM) and specialized pro-resolving mediators (SPMs) will be measured in plasma using liquid chromatography-tandem mass spectrometry (LC-MS-MS) based methods daily on days 1-3 and on day 4. The percentage change from baseline at day 1 to post treatment at day 4 is reported. A representative LM is shown (14-HDHA (14-hydroxy-4Z,7Z,10Z,12E,16Z,19Z-docosahexaenoic acid) is an oxidized metabolite of omega-3 docosahexaenoic acid (DHA)). Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number" without standard deviation, since measures of dispersion cannot be calculated.

    Time frame: 4 days

Other outcomes

  1. Ventilator-free Days at Day 28

    Ventilator-free days to day 28 are defined as the number of days from the time of initiating unassisted breathing to day 28 after randomization, assuming survival for at least two consecutive calendar days after initiating unassisted breathing and continued unassisted breathing to day 28. If a subject returns to assisted breathing and subsequently achieves unassisted breathing to day 28, VFDs will be counted from the end of the last period of assisted breathing to day 28. Participants who do not survive to day 28 are assigned zero ventilator-free days. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 28 days

  2. ICU-free Days at Day 28

    ICU-free days are the number of days that the patient is alive and free from ICU care within 28 days. Is calculated by subtracting the total number of days that the patient is free from the ICU from 28. Patients who die within 28 days are automatically assigned "0" ICU free days. We present data of ICU free days for enrolled subjects. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 28 days

  3. Hospital-free Days at Day 60

    Hospital-free days will be assessed on day 60. Hospital-free days are days alive post hospital discharge through day 60. Patients who die on or prior to day 60 are assigned zero hospital-free days. We present hospital free days at day 60. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

    Time frame: 60 days

  4. Hospital Mortality to Day 28 and 60

    Mortality will be assessed on day 28 and day 60

    Time frame: 60 days

  5. Montreal Cognitive Assessment- MoCA-Blind

    Montreal Cognitive Assessment - Blind Version (MoCA-Blind) The MoCA-Blind is a remote adaptation of the Montreal Cognitive Assessment (MoCA) used as a screening assessment for detecting cognitive impairment. It is administered via telephone interview. The MoCA-Blind assesses the following cognitive domains (points): - Attention (0-6) - Language: (0-3 (Repetition (0-2) and fluency (0-1)) - Abstraction (0-2) - Memory: Delayed recall (0-5) - Orientation (0-6) The minimum score is 0 and maximum score is 22 points. Calculated as the sum of all domains. Interpretation: Higher scores indicate better cognitive functioning. Lower scores indicate worse cognitive functioning (greater cognitive impairment). A score of 18 or above is within the normal range. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number", since given measures of dispersion cannot be calculated.

    Time frame: 6 months

  6. Hayling Sentence Completion Test

    The Hayling Sentence Completion Test assesses executive functioning (response initiation and inhibition), administered via telephone. With 30 sentence-completion items split into 2 sections (15 each). Sections: - 1: Response initiation (time to provide a contextually appropriate word). - 2: Response inhibition (time and error score for providing an unrelated word). Scores (response time and errors) from both sections are combined and converted to an age-adjusted standardized total score. Total combined standardized score ranges from 1-10: 1: Impaired 2: Abnormal 3: Poor 4: Low Average 5: Moderate Average 6: Average 7: High Average 8: Good 9: Superior 10: Very Superior Higher scores= Better executive functioning Lower scores= Greater impairment. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number", since given measures of dispersion cannot be calculated.

    Time frame: 6 months

07

Results

Posted Jun 16, 2026
Limitations and caveats
Due to low enrollment, a limited number of measurements prevents us from estimating measures of variance and dispersion.

Participant flow

First recruited subject date was 9/30/2019 and last recruited subject was 4/5/2021. The study treatment was 3 days and follow up during 60 days during hospitalization and up to 6 months follow up. Screening was conducted in Intensive Care Units and qualifying subjects were consented by study physicians at Brigham and Women's Hospital, Duke University Hospital and New York Presbyterian Brooklyn Methodist Hospital.

Participant flow — Overall Study
MilestoneInhaled Carbon MonoxideMedical Air
Started31
Completed31
Not completed00

Outcome measures

PrimaryPrimary Safety Outcome: Number of Pre-specified Administration-related Adverse Events.

Safety of inhaled CO, defined by the incidence of pre-specified administration-related AEs (as defined below) and spontaneously reported AEs through study day 7. 1. Acute MI within 48 hours of study drug administration 2. Acute cerebrovascular accident (CVA) within 48 hours of study drug administration 3. New onset atrial or ventricular arrhythmia requiring DC cardioversion within 48 hours of study drug administration 4. Increased oxygenation requirements defined as: an increase in FiO2 of ≥ 0.2 AND increase in PEEP ≥ 5 cm H2O within 6 hours of study drug administration 5. Increase in COHb ≥ 10% 6. Increase in lactate by ≥ 2 mmol/L within 6 hours of study drug administration

Time frame:
7 days
Reported as:
Count of participants · Participants
Primary Safety Outcome: Number of Pre-specified Administration-related Adverse Events.
ParticipantsInhaled Carbon MonoxideMedical Air
Acute MI within 48 hours of study drug administration00
Acute cerebrovascular accident (CVA) within 48 hours of study drug administration10
New arrhythmia requiring DC cardioversion within 48 hours of study drug administration00
Increased oxygenation: increased FiO2 ≥ 0.2 AND PEEP ≥ 5 cm H2O within 6 hrs of drug administration00
Increase in COHb ≥ 10%00
Increase in lactate by ≥ 2 mmol/L within 6 hours of study drug administration00
PrimaryPrimary Efficacy Outcome: Change in Mitochondrial DNA (mtDNA) Level From Day 1 to Day 5

Mitochondrial DNA (mtDNA) plasma levels will be measured by quantitative PCR of human NADH dehydrogenase 1. The number presented is the percentage average difference from beginning to end of treatment. Limited number of measurements prevents variance analyses; therefore we present the data from the subjects available in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
5 days
Reported as:
Mean · Percent change in Mitochondrial DNA
Primary Efficacy Outcome: Change in Mitochondrial DNA (mtDNA) Level From Day 1 to Day 5
Percent change in Mitochondrial DNAInhaled Carbon MonoxideMedical Air
Primary Efficacy Outcome: Change in Mitochondrial DNA (mtDNA) Level From Day 1 to Day 5234.14 ± 380.75-78.63 ± NA
SecondaryLung Injury Score (LIS) on Days 1-5, and on Days 1-7

The Lung Injury Score (LIS) is a composite 4-point scoring system including the PaO2/FiO2, PEEP, quasi-static respiratory compliance, and the extent of infiltrates on the chest X-ray. Each of the four components is categorized from 0 to 4, where a higher number is worse. The total Lung Injury Score is obtained by dividing the aggregate sum by the number of components used. Previous randomized clinical trials in ARDS have shown that a decreased LIS correlates with improvement in lung physiology as well as important clinical outcomes including mortality and ventilator-free days (VFDs). The number presented is the average difference from beginning to end of treatment. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
7 days
Reported as:
Mean · Percent change in Lung Injury Score
Lung Injury Score (LIS) on Days 1-5, and on Days 1-7
Percent change in Lung Injury ScoreInhaled Carbon MonoxideMedical Air
Day 1 to Day 5-5.25 ± 15.31-30 ± NA
Day 1 to Day 73.11 ± 20.23-30 ± NA
SecondaryPercent Change in PaO2/FiO2 Ratio on Days 1-5, and on Days 1-7

PaO2/FiO2 will be measured daily on days 1-5 and days 1-7 in ventilated subjects. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
7 days
Reported as:
Mean · Percent change in PaO2/FiO2 ratio
Percent Change in PaO2/FiO2 Ratio on Days 1-5, and on Days 1-7
Percent change in PaO2/FiO2 ratioInhaled Carbon MonoxideMedical Air
Day 1 to Day 532.74 ± 22.7322.42 ± NA
Day 1 to Day 719.73 ± 14.8640.60 ± NA
SecondaryPercent Change in Oxygenation Index (OI) on Days 1-5, and Days 1-7

The oxygenation index will be measured on days 1-5 and on days 1-7 in ventilated subjects. Oxygenation index is calculated as (FiO2 X mean airway pressure)/PaO2. We provide change in Oi from baseline. Oi is only measured when subjects are ventilated, therefore not all timepoints are available. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
7 days
Reported as:
Mean · Percent change in O2 index from baseline
Percent Change in Oxygenation Index (OI) on Days 1-5, and Days 1-7
Percent change in O2 index from baselineInhaled Carbon MonoxideMedical Air
Day 1 to Day 5-35.79 ± 24.04-40.09 ± NA
Day 1 to Day 7-24.31 ± 35.70-43.10 ± NA
SecondaryPercent Change in Dead Space Fraction (Vd/Vt) on Days 1-3, and Days 1-7

The dead space fraction will be measured days 1-3 and days 1-7 in ventilated subjects. We present change in dead space fraction between initial and final measurements that were available (measurements only taken while the subjects were intubated). The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
7 days
Reported as:
Mean · Percent change in Dead Space
Percent Change in Dead Space Fraction (Vd/Vt) on Days 1-3, and Days 1-7
Percent change in Dead SpaceInhaled Carbon MonoxideMedical Air
Day 1 to Day 3-14.89 ± 21.063.03 ± NA
Day 1 to Day 7-27.65 ± Na-10.60 ± NA
SecondaryPercent Change in Sequential Organ Failure Assessment (SOFA) Score on Days 1-5, and Days 1-7.

Organ failure will be assessed using the SOFA score. SOFA scores will be assessed daily on days 1-5 and day 7, as the SOFA score has been shown to be a reliable prognostic indicator of outcomes in critically ill patients. To calculate the Sequential Organ Failure Assessment (SOFA) score, each of the six components (Respiratory, Coagulation, Liver, Cardiovascular, Central Nervous System, Renal) is categorized from 0-4, where a higher number is worse. The SOFA score (0-24) will be calculated by summing all six components. We present changes in SOFA score over the time of hospitalization, over the time of ICU admission (up to days 5 and 7 for the enrolled subjects). The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
1-5 and 1-7 days
Reported as:
Mean · Percent change in SOFA score
Percent Change in Sequential Organ Failure Assessment (SOFA) Score on Days 1-5, and Days 1-7.
Percent change in SOFA scoreInhaled Carbon MonoxideMedical Air
Day 1 to Day 5-8.88 ± 8.3827.27 ± NA
Day 1 to Day 7-10.63 ± 24.02-9.09 ± NA
SecondaryAbsolute Value of Biomarkers of Inflammation and Inflammasome Activation

Cytokine plasma levels (eg. IL-1B) will be measured by ELISA daily on days 1-3 and on day 4. We report the absolute Mean Fluorescent Intensity (MFI) of each sample at pretreatment time point of day 4. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number" without standard deviation, since measures of dispersion cannot be calculated.

Time frame:
4 days
Reported as:
Number · Raw MFI units for IL-1B
Absolute Value of Biomarkers of Inflammation and Inflammasome Activation
Raw MFI units for IL-1BInhaled Carbon MonoxideMedical Air
Absolute Value of Biomarkers of Inflammation and Inflammasome Activation151.23 ± NA307.83 ± NA
SecondaryPercent Change in Lipid Mediators

Lipid mediators (LM) and specialized pro-resolving mediators (SPMs) will be measured in plasma using liquid chromatography-tandem mass spectrometry (LC-MS-MS) based methods daily on days 1-3 and on day 4. The percentage change from baseline at day 1 to post treatment at day 4 is reported. A representative LM is shown (14-HDHA (14-hydroxy-4Z,7Z,10Z,12E,16Z,19Z-docosahexaenoic acid) is an oxidized metabolite of omega-3 docosahexaenoic acid (DHA)). Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number" without standard deviation, since measures of dispersion cannot be calculated.

Time frame:
4 days
Reported as:
Number · Percent change 14-HDHA
Percent Change in Lipid Mediators
Percent change 14-HDHAInhaled Carbon MonoxideMedical Air
Percent Change in Lipid Mediators18.07 ± NA-96.8 ± NA
Other pre-specifiedVentilator-free Days at Day 28

Ventilator-free days to day 28 are defined as the number of days from the time of initiating unassisted breathing to day 28 after randomization, assuming survival for at least two consecutive calendar days after initiating unassisted breathing and continued unassisted breathing to day 28. If a subject returns to assisted breathing and subsequently achieves unassisted breathing to day 28, VFDs will be counted from the end of the last period of assisted breathing to day 28. Participants who do not survive to day 28 are assigned zero ventilator-free days. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
28 days
Reported as:
Mean · Days
Ventilator-free Days at Day 28
DaysInhaled Carbon MonoxideMedical Air
Ventilator-free Days at Day 280 ± 00 ± NA
Other pre-specifiedICU-free Days at Day 28

ICU-free days are the number of days that the patient is alive and free from ICU care within 28 days. Is calculated by subtracting the total number of days that the patient is free from the ICU from 28. Patients who die within 28 days are automatically assigned "0" ICU free days. We present data of ICU free days for enrolled subjects. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
28 days
Reported as:
Mean · Days
ICU-free Days at Day 28
DaysInhaled Carbon MonoxideMedical Air
ICU-free Days at Day 284.33 ± 4.502 ± NA
Other pre-specifiedHospital-free Days at Day 60

Hospital-free days will be assessed on day 60. Hospital-free days are days alive post hospital discharge through day 60. Patients who die on or prior to day 60 are assigned zero hospital-free days. We present hospital free days at day 60. The limited number of measurements prevent the variance and measures of dispersion calculations; therefore we present the average of data from the available subjects in each group and report as "Mean" without standard deviation, where measures of dispersion cannot be calculated.

Time frame:
60 days
Reported as:
Mean · Number of Hospital free Days at day 60
Hospital-free Days at Day 60
Number of Hospital free Days at day 60Inhaled Carbon MonoxideMedical Air
Hospital-free Days at Day 604.66 ± 8.080 ± NA
Other pre-specifiedHospital Mortality to Day 28 and 60

Mortality will be assessed on day 28 and day 60

Time frame:
60 days
Reported as:
Count of participants · Participants
Hospital Mortality to Day 28 and 60
ParticipantsInhaled Carbon MonoxideMedical Air
Day 2820
Day 6020
Other pre-specifiedMontreal Cognitive Assessment- MoCA-Blind

Montreal Cognitive Assessment - Blind Version (MoCA-Blind) The MoCA-Blind is a remote adaptation of the Montreal Cognitive Assessment (MoCA) used as a screening assessment for detecting cognitive impairment. It is administered via telephone interview. The MoCA-Blind assesses the following cognitive domains (points): - Attention (0-6) - Language: (0-3 (Repetition (0-2) and fluency (0-1)) - Abstraction (0-2) - Memory: Delayed recall (0-5) - Orientation (0-6) The minimum score is 0 and maximum score is 22 points. Calculated as the sum of all domains. Interpretation: Higher scores indicate better cognitive functioning. Lower scores indicate worse cognitive functioning (greater cognitive impairment). A score of 18 or above is within the normal range. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number", since given measures of dispersion cannot be calculated.

Time frame:
6 months
Reported as:
Number · scores on a scale
Montreal Cognitive Assessment- MoCA-Blind
scores on a scaleInhaled Carbon MonoxideMedical Air
Montreal Cognitive Assessment- MoCA-Blind10—
Other pre-specifiedHayling Sentence Completion Test

The Hayling Sentence Completion Test assesses executive functioning (response initiation and inhibition), administered via telephone. With 30 sentence-completion items split into 2 sections (15 each). Sections: - 1: Response initiation (time to provide a contextually appropriate word). - 2: Response inhibition (time and error score for providing an unrelated word). Scores (response time and errors) from both sections are combined and converted to an age-adjusted standardized total score. Total combined standardized score ranges from 1-10: 1: Impaired 2: Abnormal 3: Poor 4: Low Average 5: Moderate Average 6: Average 7: High Average 8: Good 9: Superior 10: Very Superior Higher scores= Better executive functioning Lower scores= Greater impairment. Limited number of measurements prevents variance and measures of dispersion analyses; therefore we present the data from the subjects available in each group and report as "Number", since given measures of dispersion cannot be calculated.

Time frame:
6 months
Reported as:
Number · scores on a scale
Hayling Sentence Completion Test
scores on a scaleInhaled Carbon MonoxideMedical Air
Hayling Sentence Completion Test4—

Adverse events

Collected over Adverse events were monitored from enrollment to day 7. All-Cause Mortality was assessed up to 60 days.. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Inhaled Carbon Monoxide2/3 (66.7%)3/3 (100%)0/3 (0%)
Medical Air0/1 (0%)1/1 (100%)1/1 (100%)
Most frequent serious events
Most frequent serious events
EventInhaled Carbon MonoxideMedical Air
Laryngeal edemaRespiratory, thoracic and mediastinal disorders0/31/1
Intracranial hemorrhageNervous system disorders1/30/1
Upper gastrointestinal hemorrhageGastrointestinal disorders1/30/1
Respiratory failureRespiratory, thoracic and mediastinal disorders1/30/1
Most frequent other events
Most frequent other events
EventInhaled Carbon MonoxideMedical Air
Wound infectionInfections and infestations0/31/1
SeizureNervous system disorders0/31/1

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Inhaled Carbon MonoxideMedical AirTotal
<=18 years000
Between 18 and 65 years314
>=65 years000
Sex: Female, Male
Sex: Female, Male(Participants)Inhaled Carbon MonoxideMedical AirTotal
Female213
Male101
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Inhaled Carbon MonoxideMedical AirTotal
American Indian or Alaska Native000
Asian101
Native Hawaiian or Other Pacific Islander000
Black or African American000
White112
More than one race000
Unknown or Not Reported101
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Inhaled Carbon MonoxideMedical AirTotal
Hispanic or Latino101
Not Hispanic or Latino213
Unknown or Not Reported000
Baseline Critical Illness: Acute Respiratory Distress Syndrome (ARDS)
Baseline Critical Illness: Acute Respiratory Distress Syndrome (ARDS)(Participants)Inhaled Carbon MonoxideMedical AirTotal
Count of participants314
08

Study locations

7 sites
  • Massachusetts General Hospital
    Boston, Massachusetts 02114, United States
  • Brigham and Women's Hospital
    Boston, Massachusetts 02115, United States
  • Washington University
    St Louis, Missouri 63130, United States
  • New York-Presbyterian Brooklyn Methodist Hospital
    Brooklyn, New York 11215, United States
  • Weill Cornell Medical College
    New York, New York 10065, United States
  • Duke Regional Hospital
    Durham, North Carolina 27704, United States
  • Duke University Hospital
    Durham, North Carolina 27710, United States
09

References and documents

Publications

  • Nakahira K, Kyung SY, Rogers AJ, Gazourian L, Youn S, Massaro AF, Quintana C, Osorio JC, Wang Z, Zhao Y, Lawler LA, Christie JD, Meyer NJ, Mc Causland FR, Waikar SS, Waxman AB, Chung RT, Bueno R, Rosas IO, Fredenburgh LE, Baron RM, Christiani DC, Hunninghake GM, Choi AM. Circulating mitochondrial DNA in patients in the ICU as a marker of mortality: derivation and validation. PLoS Med. 2013 Dec;10(12):e1001577; discussion e1001577. doi: 10.1371/journal.pmed.1001577. Epub 2013 Dec 31. PubMed 24391478 ↗
  • Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002 Jul 20;360(9328):219-23. doi: 10.1016/S0140-6736(02)09459-X. PubMed 12133657 ↗
  • Jung SS, Moon JS, Xu JF, Ifedigbo E, Ryter SW, Choi AM, Nakahira K. Carbon monoxide negatively regulates NLRP3 inflammasome activation in macrophages. Am J Physiol Lung Cell Mol Physiol. 2015 May 15;308(10):L1058-67. doi: 10.1152/ajplung.00400.2014. Epub 2015 Mar 13. PubMed 25770182 ↗
  • Rhodes MA, Carraway MS, Piantadosi CA, Reynolds CM, Cherry AD, Wester TE, Natoli MJ, Massey EW, Moon RE, Suliman HB. Carbon monoxide, skeletal muscle oxidative stress, and mitochondrial biogenesis in humans. Am J Physiol Heart Circ Physiol. 2009 Jul;297(1):H392-9. doi: 10.1152/ajpheart.00164.2009. Epub 2009 May 22. PubMed 19465554 ↗
  • Fredenburgh LE, Kraft BD, Hess DR, Harris RS, Wolf MA, Suliman HB, Roggli VL, Davies JD, Winkler T, Stenzler A, Baron RM, Thompson BT, Choi AM, Welty-Wolf KE, Piantadosi CA. Effects of inhaled CO administration on acute lung injury in baboons with pneumococcal pneumonia. Am J Physiol Lung Cell Mol Physiol. 2015 Oct 15;309(8):L834-46. doi: 10.1152/ajplung.00240.2015. Epub 2015 Aug 28. PubMed 26320156 ↗
  • Hausberg M, Somers VK. Neural circulatory responses to carbon monoxide in healthy humans. Hypertension. 1997 May;29(5):1114-8. doi: 10.1161/01.hyp.29.5.1114. PubMed 9149675 ↗
  • Mayr FB, Spiel A, Leitner J, Marsik C, Germann P, Ullrich R, Wagner O, Jilma B. Effects of carbon monoxide inhalation during experimental endotoxemia in humans. Am J Respir Crit Care Med. 2005 Feb 15;171(4):354-60. doi: 10.1164/rccm.200404-446OC. Epub 2004 Nov 19. PubMed 15557136 ↗
  • Peterson JE, Stewart RD. Predicting the carboxyhemoglobin levels resulting from carbon monoxide exposures. J Appl Physiol. 1975 Oct;39(4):633-8. doi: 10.1152/jappl.1975.39.4.633. PubMed 1194155 ↗
  • Stewart RD, Peterson JE, Baretta ED, Bachand RT, Hosko MJ, Herrmann AA. Experimental human exposure to carbon monoxide. Arch Environ Health. 1970 Aug;21(2):154-64. doi: 10.1080/00039896.1970.10667214. No abstract available. PubMed 5430001 ↗
  • Zevin S, Saunders S, Gourlay SG, Jacob P, Benowitz NL. Cardiovascular effects of carbon monoxide and cigarette smoking. J Am Coll Cardiol. 2001 Nov 15;38(6):1633-8. doi: 10.1016/s0735-1097(01)01616-3. PubMed 11704374 ↗
  • Ren X, Dorrington KL, Robbins PA. Respiratory control in humans after 8 h of lowered arterial PO2, hemodilution, or carboxyhemoglobinemia. J Appl Physiol (1985). 2001 Apr;90(4):1189-95. doi: 10.1152/jappl.2001.90.4.1189. PubMed 11247913 ↗
  • Pecorella SR, Potter JV, Cherry AD, Peacher DF, Welty-Wolf KE, Moon RE, Piantadosi CA, Suliman HB. The HO-1/CO system regulates mitochondrial-capillary density relationships in human skeletal muscle. Am J Physiol Lung Cell Mol Physiol. 2015 Oct 15;309(8):L857-71. doi: 10.1152/ajplung.00104.2015. Epub 2015 Jul 17. PubMed 26186946 ↗
  • Fredenburgh LE, Perrella MA, Barragan-Bradford D, Hess DR, Peters E, Welty-Wolf KE, Kraft BD, Harris RS, Maurer R, Nakahira K, Oromendia C, Davies JD, Higuera A, Schiffer KT, Englert JA, Dieffenbach PB, Berlin DA, Lagambina S, Bouthot M, Sullivan AI, Nuccio PF, Kone MT, Malik MJ, Porras MAP, Finkelsztein E, Winkler T, Hurwitz S, Serhan CN, Piantadosi CA, Baron RM, Thompson BT, Choi AM. A phase I trial of low-dose inhaled carbon monoxide in sepsis-induced ARDS. JCI Insight. 2018 Dec 6;3(23):e124039. doi: 10.1172/jci.insight.124039. PubMed 30518685 ↗
  • Rosas IO, Goldberg HJ, Collard HR, El-Chemaly S, Flaherty K, Hunninghake GM, Lasky JA, Lederer DJ, Machado R, Martinez FJ, Maurer R, Teller D, Noth I, Peters E, Raghu G, Garcia JGN, Choi AMK. A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis. Chest. 2018 Jan;153(1):94-104. doi: 10.1016/j.chest.2017.09.052. Epub 2017 Oct 31. PubMed 29100885 ↗

Study documents

  • Protocol and statistical analysis plan · Oct 27, 2022
  • Informed consent form · Apr 6, 2026

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 16, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03799874
Lead sponsor
Brigham and Women's Hospital
Collaborators
Massachusetts General Hospital, Weill Medical College of Cornell University, Duke University, Durham VA Medical Center, New York Presbyterian Brooklyn Methodist Hospital, Duke Regional Hospital, U.S. Army Medical Research Acquisition Activity, Washington University School of Medicine
Responsible party
Rebecca Baron (Associate Professor of Medicine, Brigham and Women's Hospital) — Principal investigator
First posted
Jan 10, 2019
Start date
Sep 30, 2019
Primary completion
Apr 13, 2021
Completion
Apr 13, 2021
Results posted
Jun 16, 2026
Last update
Jun 16, 2026

Study contacts

Rebecca Baron, MD
principal investigator · Brigham and Women's Hospital

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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