Gianni Stefano, Fenza Raffaele Di, Morais Caio C Araujo, Fakhr Bijan Safaee, Mueller Ariel L, Yu Binglan, Carroll Ryan W, Ichinose Fumito, Zapol Warren M, Berra Lorenzo
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts.
Respir Care. 2022 Feb;67(2):201-208. doi: 10.4187/respcare.09308. Epub 2021 Aug 19.
High-dose (≥ 80 ppm) inhaled nitric oxide (INO) has antimicrobial effects. We designed a trial to test the preventive effects of high-dose NO on coronavirus disease 2019 (COVID-19) in health care providers working with patients with COVID-19. The study was interrupted prematurely due to the introduction of COVID-19 vaccines for health care professionals. We thereby present data on safety and feasibility of breathing 160 ppm NO using 2 different NO sources, namely pressurized nitrogen/NO cylinders (INO) and electric NO (eNO) generators.
NO gas was inhaled at 160 ppm in air for 15 min twice daily, before and after each work shift, over 14 d by health care providers (NCT04312243). During NO administration, vital signs were continuously monitored. Safety was assessed by measuring transcutaneous methemoglobinemia (SpMet) and the inhaled nitrogen dioxide (NO) concentration.
Twelve healthy health care professionals received a collective total of 185 administrations of high-dose NO (160 ppm) for 15 min twice daily. One-hundred and seventy-one doses were delivered by INO and 14 doses by eNO. During NO administration, SpMet increased similarly in both groups ( = .82). Methemoglobin decreased in all subjects at 5 min after discontinuing NO administration. Inhaled NO concentrations remained between 0.70 ppm (0.63-0.79) and 0.75 ppm (0.67-0.83) in the INO group and between 0.74 ppm (0.68-0.78) and 0.88 ppm (0.70-0.93) in the eNO group. During NO administration, peripheral oxygen saturation and heart rate did not change. No adverse events occurred.
This pilot study testing high-dose INO (160 ppm) for 15 min twice daily using eNO seems feasible and similarly safe when compared with INO.
高剂量（≥80 ppm）吸入一氧化氮（INO）具有抗菌作用。我们设计了一项试验，以测试高剂量一氧化氮对与2019冠状病毒病（COVID-19）患者接触的医护人员的预防效果。由于为医护人员接种了COVID-19疫苗，该研究提前中断。因此，我们提供了使用两种不同一氧化氮来源（即加压氮气/一氧化氮气瓶（INO）和电动一氧化氮（eNO）发生器）吸入160 ppm一氧化氮的安全性和可行性数据。
医护人员（NCT04312243）在14天内，每天在每个工作班次前后，于空气中以160 ppm的浓度吸入一氧化氮气体15分钟，每日两次。在给予一氧化氮期间，持续监测生命体征。通过测量经皮高铁血红蛋白血症（SpMet）和吸入的二氧化氮（NO₂）浓度来评估安全性。
12名健康的医护人员共接受了185次高剂量一氧化氮（160 ppm）给药，每日两次，每次15分钟。其中171剂由INO提供，14剂由eNO提供。在给予一氧化氮期间，两组的SpMet升高情况相似（P = 0.82）。在停止给予一氧化氮后5分钟，所有受试者的高铁血红蛋白均下降。INO组吸入的一氧化氮浓度保持在0.70 ppm（0.63 - 0.79）至0.75 ppm（0.67 - 0.83）之间，eNO组则保持在0.74 ppm（0.68 - 0.78）至0.88 ppm（0.70 - 0.93）之间。在给予一氧化氮期间，外周血氧饱和度和心率未发生变化。未发生不良事件。
这项使用eNO每日两次、每次15分钟测试高剂量INO（160 ppm）的初步研究与INO相比似乎可行且安全性相似。
