The organ-protective effects of nitric oxide in adult patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis.

These findings indicate that some observed associations may have been influenced by small-study effects or selective publication, particularly for outcomes with marginal significance.

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In our subgroup analysis, postoperative NO administration showed a trend toward greater reduction in ventilation duration, possibly because it coincides with the peak of systemic inflammation and reperfusion injury, when exogenous NO is most needed to support endothelial function.

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Notably, while our subgroup analysis showed a reduction in AKI incidence with 40–80 ppm NO, this pattern did not reach statistical significance in meta-regression, likely due to the limited number of included studies (k = 7) and reduced analytical power of regression in small datasets.

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