Use of almitrine in spontaneously breathing patients with COVID-19 treated with high-flow nasal cannula oxygen therapy and with persistent hypoxemia

Background Almitrine, a selective pulmonary vasoconstrictor in hypoxic area, improves oxygenation in mechanically ventilated patients with COVID-19 but its effects in spontaneously breathing patients with COVID-19 remain to be determined. Methods We prospectively studied the effects of almitrine (16 µg/kg/min over 30 min followed by continuous administration in responders only) in 62 patients (66% of male, 63 [53–69] years old) with COVID-19 treated with high-flow nasal cannula oxygen therapy (HFNO) and with persistent hypoxemia, defined as a $ PaO_{2} $/$ FiO_{2} $ ratio < 100 with $ FiO_{2} $ > 80% after a single awake prone positioning session. Patients with an increase in $ PaO_{2} $/$ FiO_{2} $ ratio > 20% were considered as responders. Results Overall, almitrine increased the $ PaO_{2} $/$ FiO_{2} $ ratio by 50% (p < 0.01), decreased the partial arterial pressure of carbon dioxide by 7% (p = 0.01) whereas the respiratory rate remained unchanged and 46 (74%) patients were responders. No patient experienced right ventricular dysfunction or acute cor pulmonale. The proportion of responders was similar regardless of the CT-Scan radiological pattern: 71% for the pattern with predominant ground-glass opacities and 76% for the pattern with predominant consolidations (p = 0.65). Responders had lower intubation rate (33 vs. 88%, p < 0.01), higher ventilator-free days at 28-day (28 [20–28 ] vs. 19 [2–24] days, p < 0.01) and shorter ICU length of stay (5 [3–10] vs.12 [7–30] days, p < 0.01) than non-responders. Conclusions Almitrine could be an interesting therapy in spontaneously breathing patients with COVID-19 treated with HFNO and with persistent hypoxemia, given its effects on oxygenation without serious adverse effects regardless of the CT-Scan pattern, and potentially on intubation rate. These preliminary results need to be confirmed by further randomized studies..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:24

Enthalten in:

Respiratory research - 24(2023), 1 vom: 05. Jan.

Sprache:

Englisch

Beteiligte Personen:

Saccheri, Clément [VerfasserIn]
Morand, Lucas [VerfasserIn]
Juston, Marie [VerfasserIn]
Doyen, Denis [VerfasserIn]
Hyvernat, Hervé [VerfasserIn]
Lombardi, Romain [VerfasserIn]
Devanlay, Raphaël [VerfasserIn]
Panicucci, Émilie [VerfasserIn]
Dellamonica, Jean [VerfasserIn]
Jozwiak, Mathieu [VerfasserIn]

Links:

Volltext [kostenfrei]

Themen:

Acute respiratory distress syndrome
Awake prone positioning
COVID-19
Mechanical ventilation
Oxygenation

Anmerkungen:

© The Author(s) 2023

doi:

10.1186/s12931-022-02308-y

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2133249370

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