Mulia Eka Prasetya Budi, Luke Kevin
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Jl. Mayjen Prof. Dr. Moestopo No.6-8, Surabaya, 60286, Indonesia.
Faculty of Medicine, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No.6-8, Surabaya, 60286, Indonesia.
Egypt Heart J. 2021 Sep 16;73(1):82. doi: 10.1186/s43044-021-00208-y.
COVID-19 associated acute respiratory distress syndrome (CARDS) is a severe form of SARS CoV-2 infection and affects about 15-30% of hospitalized patients with a high mortality rate. Growing research and data suggest several available drugs with appropriate pharmacological effects to treat COVID-19.
Prostacyclin analogues are regiments for pulmonary artery hypertension. Prostacyclin analogues are expected to be beneficial in treating CARDS based on at least four rationales: (1) inhaled prostacyclin analogues improve oxygenation, V/Q mismatch, and act as an ARDS therapy alternative; (2) it alleviates direct SARS-CoV-2-related coagulopathy; (3) increases nitric oxide production; and (4) possible anti-inflammatory effect. Prostacyclin analogues are available in oral, intravenous, and inhaled forms. The inhaled form has the advantage over other forms, such as parenteral administration risks. Previously, a meta-analysis demonstrated the beneficial effects of inhaled prostaglandins for ARDS treatment, such as improved PaO2/FiO2 and PaO2 along with reduced pulmonary artery pressure. Currently, two ongoing randomized controlled trials are evaluating inhaled epoprostenol (VPCOVID [NCT04452669]) and iloprost (ILOCOVID [NCT04445246]) for severe COVID-19 patients.
Inhaled prostacyclin could be considered in patients with refractory, life-threatening hypoxia despite standard management.
新型冠状病毒肺炎相关急性呼吸窘迫综合征（CARDS）是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的一种严重形式，约15%-30%的住院患者受其影响，死亡率很高。越来越多的研究和数据表明，有几种具有适当药理作用的可用药物可用于治疗新型冠状病毒肺炎。
前列环素类似物是用于治疗肺动脉高压的药物。基于至少四个理由，前列环素类似物有望对治疗CARDS有益：（1）吸入性前列环素类似物可改善氧合、通气/血流比值失调，并可作为急性呼吸窘迫综合征的一种治疗选择；（2）它可减轻直接与SARS-CoV-2相关的凝血病；（3）增加一氧化氮生成；（4）可能具有抗炎作用。前列环素类似物有口服、静脉注射和吸入三种剂型。吸入剂型比其他剂型更具优势，如可避免肠胃外给药的风险。此前，一项荟萃分析表明吸入性前列腺素对急性呼吸窘迫综合征治疗有益，如可改善动脉血氧分压/吸入氧分数值（PaO2/FiO2）和动脉血氧分压（PaO2），同时降低肺动脉压力。目前，两项正在进行的随机对照试验正在评估吸入依前列醇（VPCOVID [NCT04452669]）和伊洛前列素（ILOCOVID [NCT04445246]）用于治疗重症新型冠状病毒肺炎患者的效果。
对于尽管接受了标准治疗仍有难治性、危及生命的低氧血症患者，可考虑使用吸入性前列环素。
