Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Jul;27(13):6422-6428. doi: 10.26355/eurrev_202307_33002.
Inhaled NO (iNO) has been recommended as rescue therapy in acute respiratory stress syndrome (ARDS) cases. In this study, we aimed to demonstrate the efficacy of iNO as a rescue therapy in patients with severe ARDS due to COVID-19.
This retrospective study included patients with ARDS due to COVID-19 who were treated with iNO between March 2020 and January 2022 in the intensive care unit (ICU) of Inonu University. Patients' files were reviewed retrospectively, and demographic data, APACHE II and Sequential Organ Failure Assessment (SOFA) scores, initiation day of iNO and duration of iNO treatment, length of stay in hospital/ICU, blood biochemistry values, complete blood counts, inflammatory parameters, arterial blood gas values, lactate, PaO2/FiO2 ratios, anti-inflammatory drugs and outcome were recorded.
Data from 16 patients were reached. iNO was given at a dose of 20 ppm continuously. The mean duration of treatment with iNO was 3.5 days. All patients took the prone position except a single patient. While all patients received steroid therapy, four patients received anti-cytokine therapy, and five patients received intravenous immunoglobulin therapy. All patients were in severe ARDS with a mean PaO2/FiO2 ratio of 58 before iNO therapy. A significant increase in PaO2/FiO2 values was detected with the use of iNO (p<0.05). While three patients (19%) were discharged from the ICU, thirteen patients died.
In our study, it was determined that iNO applied as a rescue treatment in patients with severe ARDS improved oxygenation. Although the effect of iNO on survival was low, it may be interpreted as clinically significant considering the severity of the general clinical condition of the patients.
吸入一氧化氮（iNO）已被推荐作为急性呼吸窘迫综合征（ARDS）病例的抢救治疗方法。本研究旨在证明 iNO 作为 COVID-19 引起的严重 ARDS 患者抢救治疗的疗效。
这是一项回顾性研究，纳入了 2020 年 3 月至 2022 年 1 月期间在因努大学重症监护室（ICU）接受 iNO 治疗的 COVID-19 相关 ARDS 患者。回顾性查阅患者病历，记录人口统计学数据、急性生理和慢性健康评估（APACHE）Ⅱ评分和序贯器官衰竭评估（SOFA）评分、iNO 起始时间和治疗持续时间、住院/ICU 时间、血液生化值、全血细胞计数、炎症参数、动脉血气值、乳酸、氧分压/吸入氧分数比值、抗炎药物和结局。
共纳入 16 例患者的数据。iNO 以 20ppm 的剂量连续给药。iNO 治疗的平均持续时间为 3.5 天。除了 1 例患者外，所有患者均取俯卧位。虽然所有患者均接受了类固醇治疗，但 4 例患者接受了抗细胞因子治疗，5 例患者接受了静脉注射免疫球蛋白治疗。所有患者均处于严重 ARDS 状态，iNO 治疗前的平均氧分压/吸入氧分数比值为 58。使用 iNO 后，PaO2/FiO2 值显著升高（p<0.05）。虽然 3 例（19%）患者从 ICU 出院，但 13 例患者死亡。
在本研究中，我们确定在严重 ARDS 患者中应用 iNO 作为抢救治疗可改善氧合。尽管 iNO 对生存率的影响较低，但考虑到患者一般临床状况的严重程度，其可能被认为具有临床意义。
