TY - JOUR
T1 - Inhaled pulmonary vasodilators are not associated with improved gas exchange in mechanically ventilated patients with COVID-19
T2 - A retrospective cohort study
AU - Lubinsky, Anthony Steven
AU - Brosnahan, Shari B.
AU - Lehr, Andrew
AU - Elnadoury, Ola
AU - Hagedorn, Jacklyn
AU - Garimella, Bhaskara
AU - Bender, Michael T.
AU - Amoroso, Nancy
AU - Artigas, Antonio
AU - Bos, Lieuwe D. J.
AU - Kaufman, David
N1 - Funding Information: We thank the Respiratory Care Departments at NYU Langone Medical Center, NYU Langone Brooklyn Hospital, and NYU-Long Island Hospital for their service during the COVID-19 pandemic with special thanks to Nathanael Albright, Robert Sparaco, Lisa Hoffman, Vernan Druses, Judy Ackermann, and Joy Thomas. Funding Information: AA Dr . Artigas's institution received funding from Lilly Foundation, and received research funding from Grifols, Fisher&Paykel and Aerogen . Funding Information: DK Dr. Kaufman has received research funding from Fisher & Paykel, Cheetah Medical, and the NIH/NHLBI. He is a member of the medical advisory board of Pulsion Medical Systems . Publisher Copyright: © 2022
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Purpose: Measure the effect of inhaled pulmonary vasodilators on gas exchange in mechanically ventilated patients with COVID-19. Methods: A retrospective observational cohort study at three New York University Hospitals was performed including eighty-four mechanically ventilated SARS Cov-2 nasopharyngeal PCR positive patients, sixty nine treated with inhaled nitric oxide (iNO) and fifteen with inhaled epoprostenol (iEPO). The primary outcomes were change in PAO2:FIO2 ratio, oxygenation Index (OI), and ventilatory ratio (VR) after initiation of inhaled pulmonary vasodilators. Results: There was no significant change in PAO2:FIO2ratio after initiation of iNO (mean − 4.1, 95% CI -17.3-9.0, P = 0.54) or iEPO (mean − 3.4, 95% CI -19.7-12.9, P = 0.66), in OI after initiation of iNO (mean 2.1, 95% CI-0.04-4.2, P = 0.054) or iEPO (mean − 3.4, 95% CI -19.7-12.9, P = 0.75), or in VR after initiation of iNO (mean 0.17, 95% CI -0.03-0.36, P = 0.25) or iEPO (mean 0.33, 95% CI -0.0847-0.74, P = 0.11). PAO2:FIO2, OI and VR did not significantly change over a five day period starting the day prior to drug initiation in patients who received either iNO or iEPO assessed with a fixed effects model. Conclusion: Inhaled pulmonary vasodilators were not associated with significant improvement in gas exchange in mechanically ventilated patients with COVID-19.
AB - Purpose: Measure the effect of inhaled pulmonary vasodilators on gas exchange in mechanically ventilated patients with COVID-19. Methods: A retrospective observational cohort study at three New York University Hospitals was performed including eighty-four mechanically ventilated SARS Cov-2 nasopharyngeal PCR positive patients, sixty nine treated with inhaled nitric oxide (iNO) and fifteen with inhaled epoprostenol (iEPO). The primary outcomes were change in PAO2:FIO2 ratio, oxygenation Index (OI), and ventilatory ratio (VR) after initiation of inhaled pulmonary vasodilators. Results: There was no significant change in PAO2:FIO2ratio after initiation of iNO (mean − 4.1, 95% CI -17.3-9.0, P = 0.54) or iEPO (mean − 3.4, 95% CI -19.7-12.9, P = 0.66), in OI after initiation of iNO (mean 2.1, 95% CI-0.04-4.2, P = 0.054) or iEPO (mean − 3.4, 95% CI -19.7-12.9, P = 0.75), or in VR after initiation of iNO (mean 0.17, 95% CI -0.03-0.36, P = 0.25) or iEPO (mean 0.33, 95% CI -0.0847-0.74, P = 0.11). PAO2:FIO2, OI and VR did not significantly change over a five day period starting the day prior to drug initiation in patients who received either iNO or iEPO assessed with a fixed effects model. Conclusion: Inhaled pulmonary vasodilators were not associated with significant improvement in gas exchange in mechanically ventilated patients with COVID-19.
KW - ARDS
KW - COVID-19
KW - Epoprostenol
KW - Inhaled nitric oxide
KW - Respiratory failure
KW - Ventilatory ratio
UR - http://www.scopus.com/inward/record.url?scp=85124593516&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2022.153990
DO - https://doi.org/10.1016/j.jcrc.2022.153990
M3 - Article
C2 - 35180636
SN - 0883-9441
VL - 69
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 153990
ER -