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All Studies   Meta Analysis    Recent:   

Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19

Chandel et al., Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, doi:10.1177/11795484211047065
Jan 2021  
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0 0.5 1 1.5 2+ Mortality -54% Improvement Relative Risk Ventilation -27% Nitric Oxide  Chandel et al.  LATE TREATMENT Is late treatment with nitric oxide beneficial for COVID-19? Retrospective 272 patients in the USA (March - June 2020) Higher mortality (p=0.25) and ventilation (p=0.26), not sig. c19early.org Chandel et al., Clinical Medicine Insi.., Jan 2021 Favors nitric oxide Favors control
Retrospective 272 acute respiratory failure patients in the USA treated with high-flow nasal cannula, 66 treated with inhaled nitric oxide, showing increased mortality with inhaled nitric oxide. There were significant differences in the usage of several other treatments between the groups.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be more beneficial).
risk of death, 54.1% higher, RR 1.54, p = 0.25, treatment 12 of 66 (18.2%), control 36 of 206 (17.5%), adjusted per study, odds ratio converted to relative risk, multivariable.
risk of mechanical ventilation, 27.2% higher, RR 1.27, p = 0.26, treatment 29 of 66 (43.9%), control 79 of 206 (38.3%), adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chandel et al., 31 Jan 2021, retrospective, USA, peer-reviewed, 14 authors, study period 1 March, 2020 - 9 June, 2020. Contact: abhimanyu.chandel.mil@mail.mil.
This PaperNitric OxideAll
Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
Abhimanyu Chandel, Saloni Patolia, Kareem Ahmad, Shambhu Aryal, A Whitney Brown, Dhwani Sahjwani, Vikramjit Khangoora, Oksana A Shlobin, Paula C Cameron, Anju Singhal, Arthur W Holtzclaw, Mehul Desai, Steven D Nathan, Christopher S King
Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, doi:10.1177/11795484211047065
INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure. METHODS: We performed a multicenter cohort study of patients with respiratory failure from COVID-19 managed with HFNC. Patients were stratified by administration of iNO via HFNC. Regression analysis was used to compare the need for mechanical ventilation and secondary endpoints including hospital mortality, length of stay, acute kidney injury, need for renal replacement therapy, and need for extracorporeal life support. RESULTS: A total of 272 patients were identified and 66 (24.3%) of these patients received iNO via HFNC for a median of 88 h (interquartile range: 44, 135). After 12 h of iNO, supplemental oxygen requirement was unchanged or increased in 52.7% of patients. Twenty-nine (43.9%) patients treated with iNO compared to 79 (38.3%) patients without iNO therapy required endotracheal intubation (P = .47). After multivariable adjustment, there was no difference in need for mechanical ventilation between groups (odds ratio: 1.53; 95% confidence interval [CI]: 0.74-3.17), however, iNO administration was associated with longer hospital length of stay (incidence rate ratio: 1.41; 95% CI: 1.31-1.51). No difference was found for mortality, acute kidney injury, need for renal replacement therapy, or need for extracorporeal life support. CONCLUSION: In patients with COVID-19 respiratory failure, iNO delivered via HFNC did not reduce oxygen requirements in the majority of patients or improve clinical outcomes. Given the observed association with increased length of stay, judicious selection of those likely to benefit from this therapy is warranted.
Author Contributions AC and CSK are the guarantors of the content of the manuscript and contributed to all aspects of the project. SP, KA, SA, AWB, DS, VK, OAS, AS, AWH, MD, and SDN contributed substantially to project design, data collection, and ORCID iD Abhimanyu Chandel https://orcid.org/0000-0003-4879-1983
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Late treatment
is less effective
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