EIT-assessed ventilation–perfusion responses to prone positioning and inhaled nitric oxide in mechanically ventilated COVID-19-related ARDS: a prospective sequential study
et al., Journal of Intensive Care, doi:10.1186/s40560-026-00918-y, NCT05715762, Jul 2026
Nitric Oxide for COVID-19
43rd treatment shown to reduce risk in
June 2022, now with p = 0.013 from 14 studies, recognized in 10 countries.
No treatment is 100% effective.
Protocols combine treatments.
Prospective study of 28 mechanically ventilated patients with moderate/severe COVID-19-related ARDS showing that both prone positioning (PP) and inhaled nitric oxide (iNO) improved short-term systemic oxygenation.
Wang et al., 22 Jul 2026, prospective, China, peer-reviewed, median age 74.0, 8 authors, study period December 2022 - March 2023, trial NCT05715762 (history).
Contact: zhanqizhao@gzhmu.edu.cn, liu.kai1@zs-hospital.sh.cn, zhong.ming@zs-hospital.sh.cn.
Abstract: ## RESEARCH
Open Access
EIT-assessed ventilation-perfusion responses to prone positioning and inhaled nitric oxide in mechanically ventilated COVID-19-related ARDS: a prospective sequential study
Yuxian Wang 1† , Yuyang Dai 1† , Xin Zheng 1† , Ling Zhu 1 , Yaxiaerjiang Muhetaer 1 , Zhanqi Zhao 2,3,4* , Kai Liu 1* and Ming Zhong 1,5*
Abstract
Background Prone positioning (PP) and inhaled nitric oxide (iNO) are widely utilized rescue therapies for severe hypoxemia during invasive mechanical ventilation. However, their combined effects on regional ventilation-perfusion (V/Q) matching remain incompletely characterized. This study utilized single-plane saline-contrast electrical impedance tomography (EIT) to achieve real-time bedside visualization and evaluate the relative spatial mechanisms of these interventions in patients with COVID-19-related ARDS.
Methods We conducted a prospective sequential physiological study in mechanically ventilated patients with moderate-to-severe COVID-19-related acute respiratory distress syndrome (ARDS). Relative regional ventilation, perfusion, and V/Q matching distributions were monitored across four predefined, fixed sequential conditions: supine position ventilation (SPV), SPV with iNO (20 ppm for 1 h; SPV + iNO), prone position ventilation after stabilization (PPV), and PPV with an additional 1 h of iNO (PPV + iNO). Primary analyses focused on prespecified within-patient contrasts, supplemented by exploratory difference-in-differences (DiD) analyses to evaluate position-dependent vascular responses.
Results Twenty-eight patients completed all study phases. Hemodynamics and conventional respiratory mechanics remained remarkably stable across all four conditions. Systemic oxygenation improved progressively; both SPV + iNO and PPV significantly increased PaO 2 and PaO 2 /FiO 2 compared to SPV alone, while the addition of iNO during PPV (PPV + iNO) yielded further oxygenation improvements and reduced FiO 2 requirements. Within the EIT-assessed thoracic slice, SPV + iNO produced the most widespread V/Q improvements, significantly reducing the global nonperfused fraction (-7.28%), wasted ventilation (-8.14%), wasted perfusion (-5.89%), and the global inhomogeneity of perfusion (GIper). Transitioning to PPV similarly reduced the global non-perfused fraction (-8.76%) and GIper, while ventral-to-dorsal ventilation distribution remained stable. Notably, while PPV + iNO improved systemic
† Yuxian Wang, Yuyang Dai and Xin Zheng have contributed equally to this work.
*Correspondence: Zhanqi Zhao zhanqizhao@gzhmu.edu.cn Kai Liu liu.kai1@zs-hospital.sh.cn Ming Zhong zhong.ming@zs-hospital.sh.cn Full list of author information is available at the end of the article
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in..
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