Retrospective 103 mechanically ventilated patients, 41 treated with inhaled nitric oxide, and 62 with inhaled epoprostenol, showing no significant difference in outcomes.
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, 13.6% lower, RR 0.86, p = 0.10, treatment 32 of 41 (78.0%), control 56 of 62 (90.3%), NNT 8.1.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Poonam et al., 27 Jun 2022, retrospective, USA, peer-reviewed, 5 authors, study period 1 March, 2020 - 30 June, 2020, this trial compares with another treatment - results may be better when compared to placebo.
Nitric oxide versus epoprostenol for refractory hypoxemia in Covid-19
PLOS ONE, doi:10.1371/journal.pone.0270646
Objective To compare the efficacy and outcomes with inhaled nitric oxide (iNO) and inhaled epoprostenol (iEPO) in patients with refractory hypoxemia due to COVID-19.
Design Retrospective Cohort Study.
Setting Single health system multicenter academic teaching hospitals.
Patients OR subjects Age group of 18-80 years admitted to the medical ICU.
Interventions Mechanically ventilated patients with COVID-19 infection, who
Supporting information S1
Alhazzani, Møller, Arabi, Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19), Intensive Care Med, doi:10.1007/s00134-020-06022-5
Ammar, Bauer, Bass, Noninferiority of Inhaled Epoprostenol to Inhaled Nitric Oxide for the Treatment of ARDS, Annals of Pharmacotherapy, doi:10.1177/1060028015595642
Boisrame, Helms, Kremer, Schini-Kerth, Endothelial dysfunction in sepsis, Curr Vasc Pharmacol
Fuller, Mohr, Skrupky, The use of inhaled prostaglandins in patients with ARDS: a systematic review and meta-analysis, Chest, doi:10.1378/chest.14-3161
Gattinoni, Chiumello, Caironi, COVID-19 pneumonia: different respiratory treatments for different phenotypes?, Intensive Care Med, doi:10.1007/s00134-020-06033-2
Gonzales, Lucas, Verin, The Acute Respiratory Distress Syndrome: Mechanisms and Perspective Therapeutic Approaches, Austin J Vasc Med
Jeremy, Szumita Paul, Schuler Brian, Evaluation of the Efficacy and Safety of Inhaled Epoprostenol and Inhaled Nitric Oxide for Refractory Hypoxemia in Patients With Coronavirus Disease, doi:10.1097/CCE.0000000000000259
Kallet, Burns, Zhuo, Severity of hypoxemia and other factors that influence the response to aerosolized prostacyclin in ARDS, Respir Care, doi:10.4187/respcare.05268
Li, Fink, Augustynovich, Effects of Inhaled Epoprostenol and Prone Positioning in Intubated Coronavirus Disease 2019 Patients With Refractory Hypoxemia, Crit Care Explor, doi:10.1097/CCE.0000000000000307
Lotz, Muellenbach, Meybohm, Effects of inhaled nitric oxide in COVID-19-induced ARDS-Is it worthwhile?, Acta Anaesthesiol Scand, doi:10.1111/aas.13757
Potus, Mai, Lebret, Novel insights on the pulmonary vascular consequences of COVID-19, Am J Physiol Lung Cell Mol Physiol, doi:10.1152/ajplung.00195.2020
Price, Garfield, Bleakley, Rescue therapy with thrombolysis in patients with severe COVID-19-associated acute respiratory distress syndrome, Pulm Circ, doi:10.1177/2045894020973906
Rocca, Coccia, Pompei, Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled prostacyclin, J Cardiothorac Vasc Anesth, doi:10.1053/jcan.2001.21974
Sonti, Pike, Cobb, Responsiveness of Inhaled Epoprostenol in Respiratory Failure due to COVID-19, Journal of Intensive Care Medicine, doi:10.1177/0885066620976525
Torbic, Szumita, Anger, Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients, J Crit Care, doi:10.1016/j.jcrc.2013.03.006
Walmrath, Schneider, Schermuly, Direct comparison of inhaled nitric oxide and aerosolized prostacyclin in acute respiratory distress syndrome, Am J Respir Crit Care Med, doi:10.1164/ajrccm.153.3.8630585
Wang, Hu, Hu, Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA, doi:10.1001/jama.2020.1585
Wu, Chen, Cai, Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China, JAMA Intern Med, doi:10.1001/jamainternmed.2020.0994