Inhaled nitric oxide in patients with acute respiratory distress syndrome caused by COVID-19 : treatment modalities, clinical response, and outcomes

© 2023. The Author(s)..

BACKGROUND: Inhaled nitric oxide (iNO) has been widely used in patients with COVID-19-related acute respiratory distress syndrome (C-ARDS), though its physiological effects and outcome are debated in this setting. The objective of this cohort study was to describe the modalities of iNO use, clinical response, and outcomes in a large cohort of C-ARDS patients.

METHODS: Multicentre, retrospective cohort study conducted in France.

RESULTS: From end February to December 2020, 300 patients (22.3% female) were included, 84.5% were overweight and 69.0% had at least one comorbidity. At ICU admission, their median (IQR) age, SAPS II, and SOFA score were 66 (57-72) years, 37 (29-48), and 5 (3-8), respectively. Patients were all ventilated according to a protective ventilation strategy, and 68% were prone positioned before iNO initiation. At iNO initiation, 2%, 37%, and 61% of patients had mild, moderate, and severe ARDS, respectively. The median duration of iNO treatment was 2.8 (1.1-5.5) days with a median dosage of 10 (7-13) ppm at initiation. Responders (PaO2/FiO2 ratio improving by 20% or more) represented 45.7% of patients at 6 h from iNO initiation. The severity of ARDS was the only predictive factor associated with iNO response. Among all evaluable patients, the crude mortality was not significantly different between responders at 6 h and their counterparts. Of the 62 patients with refractory ARDS (who fulfilled extracorporeal membrane oxygenation criteria before iNO initiation), 32 (51.6%) no longer fulfilled these criteria after 6 h of iNO. The latter showed significantly lower mortality than the other half (who remained ECMO eligible), including after confounder adjustment (adjusted OR: 0.23, 95% CI 0.06, 0.89, p = 0.03).

CONCLUSIONS: Our study reports the benefits of iNO in improving arterial oxygenation in C-ARDS patients. This improvement seems more relevant in the most severe cases. In patients with ECMO criteria, an iNO-driven improvement in gas exchange was associated with better survival. These results must be confirmed in well-designed prospective studies.

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:13

Enthalten in:

Annals of intensive care - 13(2023), 1 vom: 27. Juni, Seite 57

Sprache:

Englisch

Beteiligte Personen:

Mekontso Dessap, Armand [VerfasserIn]
Papazian, Laurent [VerfasserIn]
Schaller, Manuella [VerfasserIn]
Nseir, Saad [VerfasserIn]
Megarbane, Bruno [VerfasserIn]
Haudebourg, Luc [VerfasserIn]
Timsit, Jean-François [VerfasserIn]
Teboul, Jean-Louis [VerfasserIn]
Kuteifan, Khaldoun [VerfasserIn]
Gainnier, Marc [VerfasserIn]
Slama, Michel [VerfasserIn]
Houeto, Patrick [VerfasserIn]
Lecourt, Laurent [VerfasserIn]
Mercat, Alain [VerfasserIn]
Vieillard-Baron, Antoine [VerfasserIn]

Links:

Volltext

Themen:

Acute respiratory distress syndrome
COVID-19
ECMO
Inhaled nitric oxide
Journal Article
Refractory hypoxaemia

Anmerkungen:

Date Revised 01.07.2023

published: Electronic

Citation Status PubMed-not-MEDLINE

doi:

10.1186/s13613-023-01150-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM358693837