Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study
(1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricu...
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MDPI AG
2024-03-01
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Online Access: | https://www.mdpi.com/2077-0383/13/6/1555 |
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author | Stefan Muenster Jennifer Nadal Jens-Christian Schewe Heidi Ehrentraut Stefan Kreyer Christian Putensen Stefan Felix Ehrentraut |
author_facet | Stefan Muenster Jennifer Nadal Jens-Christian Schewe Heidi Ehrentraut Stefan Kreyer Christian Putensen Stefan Felix Ehrentraut |
author_sort | Stefan Muenster |
collection | DOAJ |
description | (1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricular failure (RV failure). (2) <b>Methods</b>: Out of 662 ECMO-supported patients, 366 received VV ECMO, including 48 who inhaled NO. We examined the NO’s indications, dosing, duration, and the ability to lower PAH. We compared patients with and without inhaled NO in terms of mechanical ventilation duration, ECMO weaning, organ dysfunction, in-hospital mortality, and survival. (3) <b>Results</b>: Patients received 14.5 ± 5.5 ppm NO for 3 days with only one-third experiencing decreased pulmonary arterial pressure. They spent more time on VV ECMO, had a higher ECMO weaning failure frequency, and elevated severity scores (SAPS II and TIPS). A Kaplan–Meier analysis revealed reduced survival in the NO group. Multiple variable logistic regression indicated a twofold increased risk of death for ARDS patients on VV ECMO with NO. We observed no increase in continuous renal replacement therapy. (4) <b>Conclusions</b>: This study suggests that persistent PAH and/or RV failure is associated with poorer outcomes in severe ARDS patients on VV-ECMO, with an inhaled NO responder rate of only 30%, and it does not impact acute kidney failure rates. |
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issn | 2077-0383 |
language | English |
last_indexed | 2024-04-24T18:09:22Z |
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series | Journal of Clinical Medicine |
spelling | doaj.art-927874409ed1401a80bfc37ab8c95dfc2024-03-27T13:47:41ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01136155510.3390/jcm13061555Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational StudyStefan Muenster0Jennifer Nadal1Jens-Christian Schewe2Heidi Ehrentraut3Stefan Kreyer4Christian Putensen5Stefan Felix Ehrentraut6Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyInstitute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany(1) <b>Background</b>: This retrospective study focused on severe acute respiratory distress syndrome (ARDS) patients treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) and who inhaled nitric oxide (NO) for pulmonary arterial hypertension (PAH) and/or right ventricular failure (RV failure). (2) <b>Methods</b>: Out of 662 ECMO-supported patients, 366 received VV ECMO, including 48 who inhaled NO. We examined the NO’s indications, dosing, duration, and the ability to lower PAH. We compared patients with and without inhaled NO in terms of mechanical ventilation duration, ECMO weaning, organ dysfunction, in-hospital mortality, and survival. (3) <b>Results</b>: Patients received 14.5 ± 5.5 ppm NO for 3 days with only one-third experiencing decreased pulmonary arterial pressure. They spent more time on VV ECMO, had a higher ECMO weaning failure frequency, and elevated severity scores (SAPS II and TIPS). A Kaplan–Meier analysis revealed reduced survival in the NO group. Multiple variable logistic regression indicated a twofold increased risk of death for ARDS patients on VV ECMO with NO. We observed no increase in continuous renal replacement therapy. (4) <b>Conclusions</b>: This study suggests that persistent PAH and/or RV failure is associated with poorer outcomes in severe ARDS patients on VV-ECMO, with an inhaled NO responder rate of only 30%, and it does not impact acute kidney failure rates.https://www.mdpi.com/2077-0383/13/6/1555inhaled nitric oxidesevere ARDSVV ECMOpulmonary hypertensioninhaled nitric oxide responder |
spellingShingle | Stefan Muenster Jennifer Nadal Jens-Christian Schewe Heidi Ehrentraut Stefan Kreyer Christian Putensen Stefan Felix Ehrentraut Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study Journal of Clinical Medicine inhaled nitric oxide severe ARDS VV ECMO pulmonary hypertension inhaled nitric oxide responder |
title | Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study |
title_full | Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study |
title_fullStr | Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study |
title_full_unstemmed | Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study |
title_short | Analysis of Patients with Severe ARDS on VV ECMO Treated with Inhaled NO: A Retrospective Observational Study |
title_sort | analysis of patients with severe ards on vv ecmo treated with inhaled no a retrospective observational study |
topic | inhaled nitric oxide severe ARDS VV ECMO pulmonary hypertension inhaled nitric oxide responder |
url | https://www.mdpi.com/2077-0383/13/6/1555 |
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