Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study

{ 'indexed': {'date-parts': [[2022, 10, 4]], 'date-time': '2022-10-04T05:05:01Z', 'timestamp': 1664859901583}, 'reference-count': 45, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2022, 10, 3]], 'date-time': '2022-10-03T00:00:00Z', 'timestamp': 1664755200000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2022, 10, 3]], 'date-time': '2022-10-03T00:00:00Z', 'timestamp': 1664755200000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>Inhaled nitric oxide (iNO) is used as rescue therapy in patients with ' 'refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) ' 'despite the recommendation against the use of this treatment. To date, the effect of iNO on ' 'the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS ' 'remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill ' 'COVID-19 patients with moderate-to-severe ARDS.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>This multicenter, retrospective cohort study included critically ill ' 'adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. ' 'Eligible patients\xa0with\xa0moderate-to-severe ARDS\xa0were subsequently categorized into ' 'two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary ' 'endpoint was the improvement in oxygenation parameters 24\xa0h after iNO use. Other outcomes ' 'were considered secondary. Propensity score matching (1:2) was used based on the predefined ' 'criteria.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>A total of 1598 patients were screened, and 815 were included based ' 'on the eligibility criteria. Among them, 210 patients were matched based on predefined ' 'criteria. Oxygenation parameters (PaO<jats:sub>2</jats:sub>, FiO<jats:sub>2</jats:sub> ' 'requirement, P/F ratio, oxygenation index) were\xa0significantly improved 24\xa0h after iNO ' 'administration within a median of six\xa0days of ICU admission. However, the risk of\xa0' '30-day and in-hospital mortality were\xa0found to be similar between the two groups (HR: ' '1.18; 95% CI: 0.77, 1.82; <jats:italic>p</jats:italic>\u2009=\u20090.45 and HR: 1.40; 95% CI: ' '0.94, 2.11; <jats:italic>p</jats:italic>=\u20090.10, respectively). On the other hand, ' 'ventilator-free days (VFDs) were significantly fewer, and \xa0ICU and hospital LOS were ' 'significantly longer in the iNO group. In addition, patients who received iNO had higher odds ' 'of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), <jats:italic>p</jats:italic> ' 'value\u2009=\u20090.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, ' '5.83), <jats:italic>p</jats:italic> value\u2009=\u20090.001).</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO ' 'rescue therapy is associated with improved oxygenation parameters but no mortality benefits. ' 'Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and\xa0fewer ' 'VFDs.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s13054-022-04158-y', 'type': 'journal-article', 'created': {'date-parts': [[2022, 10, 3]], 'date-time': '2022-10-03T11:02:41Z', 'timestamp': 1664794961000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill ' 'patients with COVID-19: a multicenter cohort study', 'prefix': '10.1186', 'volume': '26', 'author': [ {'given': 'Khalid', 'family': 'Al Sulaiman', 'sequence': 'first', 'affiliation': []}, {'given': 'Ghazwa B.', 'family': 'Korayem', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ali F.', 'family': 'Altebainawi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Shmeylan', 'family': 'Al Harbi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abdulrahman', 'family': 'Alissa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abdullah', 'family': 'Alharthi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Raed', 'family': 'Kensara', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amjaad', 'family': 'Alfahed', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ramesh', 'family': 'Vishwakarma', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hussain', 'family': 'Al Haji', 'sequence': 'additional', 'affiliation': []}, {'given': 'Naif', 'family': 'Almohaimid', 'sequence': 'additional', 'affiliation': []}, {'given': 'Omar', 'family': 'Al Zumai', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fahad', 'family': 'Alrubayan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abdulmajid', 'family': 'Asiri', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nasser', 'family': 'Alkahtani', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abdulaziz', 'family': 'Alolayan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Samiah', 'family': 'Alsohimi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nawal', 'family': 'Melibari', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alaa', 'family': 'Almagthali', 'sequence': 'additional', 'affiliation': []}, {'given': 'Seba', 'family': 'Aljahdali', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abeer A.', 'family': 'Alenazi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alawi S.', 'family': 'Alsaeedi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ghassan', 'family': 'Al Ghamdi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Omar', 'family': 'Al Faris', 'sequence': 'additional', 'affiliation': []}, {'given': 'Joud', 'family': 'Alqahtani', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jalal', 'family': 'Al Qahtani', 'sequence': 'additional', 'affiliation': []}, {'given': 'Khalid A.', 'family': 'Alshammari', 'sequence': 'additional', 'affiliation': []}, {'given': 'Khalil I.', 'family': 'Alshammari', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ohoud', 'family': 'Aljuhani', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2022, 10, 3]]}, 'reference': [ { 'key': '4158_CR1', 'doi-asserted-by': 'publisher', 'first-page': '1054', 'DOI': '10.1016/S0140-6736(20)30566-3', 'volume': '395', 'author': 'F Zhou', 'year': '2020', 'unstructured': 'Zhou F, Yu T, Du R, et al. 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