einstein (São Paulo). 29/jul/2024;22:eAO0578.

Inhaled nitric oxide in moderate-to-severe COVID-19 acute respiratory distress syndrome: a retrospective cohort study

Lucas Eduardo Benthien

Santos

, Camila Campos Grisa

Padovese

, Isabela Belarmino Oliveira de

Castro

, Rodrigo Carneiro

Franco

, Ana Paula Pires Bolsoni

Okuda

, Mariana Resende

Bustamante

, Luciana

Gioli-Pereira

DOI: 10.31744/einstein_journal/2024AO0578

Highlights

Acute respiratory distress syndrome is a severe presentation of COVID-19 without effective treatment despite intensive research.
Inhaled nitric oxide is a vasodilator that has been studied in patients with acute respiratory distress syndrome COVID-19 yielding contradictory results.
The use of inhaled nitric oxide rescue therapy in critically ill patients with COVID-19 experiencing moderate-to-severe acute respiratory distress syndrome was significantly associated with an improvement in oxygenation parameters with no difference in mortality.

ABSTRACT

Objective:

To evaluate the responsiveness of COVID-19 acute respiratory distress syndrome patients to inhaled nitric oxide as part of their standard therapy.

Methods:

This retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated between March 2020 and May 2021. Eligible patients with moderate-to-severe acute respiratory distress syndrome due to COVID-19 were subsequently categorized into two groups based on inhaled nitric oxide use throughout their stay in the intensive care unit. The primary endpoints were overall mortality and improvement in oxygenation parameters 6 hours after inhaled nitric oxide use.

Results:

A total of 481 patients admitted to the intensive care unit due to COVID-19 acute respiratory distress syndrome were screened, 105 of which were included. Among the 105 patients, inhaled nitric oxide therapy was used in 33 patients, will 72 did not undergo inhaled nitric oxide therapy. No significant difference in mortality was observed between the groups (67% for the treatment and 82% for the no-treatment groups respectively, p=0.173). Among the patients who used inhaled nitric oxide, 17 (51%) were considered responsive to therapy. There was no significant difference in the length of stay in the intensive care unit (p=0.324) or total hospitalization time (p=0.344).

Conclusion:

Inhaled nitric oxide rescue therapy improved oxygenation in patients with COVID-19 with moderate-to-severe acute respiratory distress syndrome but did not affect mortality.

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