Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2024 Aug 16;22:eAO0578. doi: 10.31744/einstein_journal/2024AO0578. eCollection 2024.
In this study, we present the findings from a cohort of patients with COVID-19 with acute respiratory distress syndrome who underwent standard therapy, including prone positioning, with or without adjunctive inhalation of nitric oxide. Our investigation sought to determine whether inhaled nitric oxide administration yielded clinical enhancement in this population. Remarkably, nitric oxide administration elevated the PaO2/FiO2 ratio, which is indicative of improved oxygenation. Despite this improvement, discernible mortality benefits did not emerge in association with the inhaled nitric oxide treatment. To evaluate the responsiveness of COVID-19 acute respiratory distress syndrome patients to inhaled nitric oxide as part of their standard therapy.
This retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated between March 2020 and May 2021. Eligible patients with moderate-to-severe acute respiratory distress syndrome due to COVID-19 were subsequently categorized into two groups based on inhaled nitric oxide use throughout their stay in the intensive care unit. The primary endpoints were overall mortality and improvement in oxygenation parameters 6 hours after inhaled nitric oxide use.
A total of 481 patients admitted to the intensive care unit due to COVID-19 acute respiratory distress syndrome were screened, 105 of which were included. Among the 105 patients, inhaled nitric oxide therapy was used in 33 patients, will 72 did not undergo inhaled nitric oxide therapy. No significant difference in mortality was observed between the groups (67% for the treatment and 82% for the no-treatment groups respectively, p=0.173). Among the patients who used inhaled nitric oxide, 17 (51%) were considered responsive to therapy. There was no significant difference in the length of stay in the intensive care unit (p=0.324) or total hospitalization time (p=0.344).
Inhaled nitric oxide rescue therapy improved oxygenation in patients with COVID-19 with moderate-to-severe acute respiratory distress syndrome but did not affect mortality.
本研究报告了一组接受标准治疗（包括俯卧位通气）的 COVID-19 合并急性呼吸窘迫综合征患者的研究结果，其中部分患者联合使用了吸入一氧化氮。我们旨在探讨吸入一氧化氮治疗在该人群中的临床疗效。结果表明，吸入一氧化氮可提高患者的 PaO2/FiO2 比值，提示氧合改善。尽管存在这种改善，但与吸入一氧化氮治疗相关的死亡率并未显著降低。本研究旨在评估 COVID-19 急性呼吸窘迫综合征患者对吸入一氧化氮治疗的反应性，将其作为标准治疗的一部分。
这是一项回顾性队列研究，纳入了 2020 年 3 月至 2021 年 5 月期间接受治疗的确诊 COVID-19 的危重症成年患者。根据 COVID-19 导致的中度至重度急性呼吸窘迫综合征，将符合条件的患者分为两组，一组为入住 ICU 期间持续使用吸入一氧化氮治疗，另一组未使用。主要终点是总体死亡率和吸入一氧化氮使用后 6 小时的氧合参数改善情况。
共筛选了 481 例因 COVID-19 急性呼吸窘迫综合征而入住 ICU 的患者，其中 105 例符合纳入标准。在这 105 例患者中，33 例接受了吸入一氧化氮治疗，72 例未接受吸入一氧化氮治疗。两组死亡率无显著差异（治疗组为 67%，未治疗组为 82%，p=0.173）。在接受吸入一氧化氮治疗的患者中，有 17 例（51%）对治疗有反应。两组患者的 ICU 住院时间（p=0.324）或总住院时间（p=0.344）均无显著差异。
吸入一氧化氮抢救治疗可改善 COVID-19 合并中重度急性呼吸窘迫综合征患者的氧合，但不能降低死亡率。
