Department of Anesthesia, the Department of Pediatrics, the Respiratory Care Department, the Department of Obstetrics and Gynecology, and the Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; and the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2020 Dec;136(6):1109-1113. doi: 10.1097/AOG.0000000000004128.
Rescue therapies to treat or prevent progression of coronavirus disease 2019 (COVID-19) hypoxic respiratory failure in pregnant patients are lacking.
To treat pregnant patients meeting criteria for severe or critical COVID-19 with high-dose (160-200 ppm) nitric oxide by mask twice daily and report on their clinical response.
Six pregnant patients were admitted with severe or critical COVID-19 at Massachusetts General Hospital from April to June 2020 and received inhalational nitric oxide therapy. All patients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A total of 39 treatments was administered. An improvement in cardiopulmonary function was observed after commencing nitric oxide gas, as evidenced by an increase in systemic oxygenation in each administration session among those with evidence of baseline hypoxemia and reduction of tachypnea in all patients in each session. Three patients delivered a total of four neonates during hospitalization. At 28-day follow-up, all three patients were home and their newborns were in good condition. Three of the six patients remain pregnant after hospital discharge. Five patients had two negative test results on nasopharyngeal swab for SARS-CoV-2 within 28 days from admission.
Nitric oxide at 160-200 ppm is easy to use, appears to be well tolerated, and might be of benefit in pregnant patients with COVID-19 with hypoxic respiratory failure.
目前缺乏治疗或预防新型冠状病毒病 2019（COVID-19）孕妇缺氧性呼吸衰竭的抢救疗法。
通过面罩每天两次给予高剂量（160-200ppm）一氧化氮治疗符合重症或危重症 COVID-19 标准的孕妇，并报告其临床反应。
2020 年 4 月至 6 月，马萨诸塞州综合医院收治了 6 名患有严重或危重症 COVID-19 的孕妇，并接受了吸入性一氧化氮治疗。所有患者均对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染检测呈阳性。开始使用一氧化氮气体后，心肺功能得到改善，证据是基线低氧血症的每个治疗阶段的全身氧合均增加，每个治疗阶段的所有患者的呼吸急促均减少。3 名患者在住院期间共分娩了 4 名新生儿。在 28 天的随访中，所有 3 名患者均已出院，其新生儿状况良好。6 名患者中有 3 名在出院后仍处于妊娠状态。5 名患者在入院后 28 天内两次鼻咽拭子 SARS-CoV-2 检测均为阴性。
160-200ppm 的一氧化氮易于使用，似乎耐受性良好，对 COVID-19 合并缺氧性呼吸衰竭的孕妇可能有益。
