Inhaled nitric oxide in patients with acute respiratory distress syndrome caused by COVID-19: treatment modalities, clinical response, and outcomes - 08/01/26
, Laurent Papazian 4, Manuella Schaller 5, Saad Nseir 6, Bruno Megarbane 7, Luc Haudebourg 8, Jean-François Timsit 9, Jean-Louis Teboul 10, Khaldoun Kuteifan 11, Marc Gainnier 12, Michel Slama 13, Patrick Houeto 5, Laurent Lecourt 5, Alain Mercat 14, Antoine Vieillard-Baron 15, 16
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Abstract |
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 (PaO 2 /FiO 2 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.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, Acute respiratory distress syndrome, Inhaled nitric oxide, Refractory hypoxaemia, ECMO
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Vol 13 - N° 1
Article 57- 2023 Retour au numéro
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