Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is manifested by an acute respiratory distress syndrome (ARDS) with intense inflammation and endothelial dysfunction leading to particularly severe hypoxemia. We hypothesized that an impaired hypoxic pulmonary vasoconstrictio...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-07-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.655763/full |
| _version_ | 1818644030984028160 |
|---|---|
| author | Driss Laghlam Ghilas Rahoual Julien Malvy Philippe Estagnasié Alain Brusset Pierre Squara |
| author_facet | Driss Laghlam Ghilas Rahoual Julien Malvy Philippe Estagnasié Alain Brusset Pierre Squara |
| author_sort | Driss Laghlam |
| collection | DOAJ |
| description | Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is manifested by an acute respiratory distress syndrome (ARDS) with intense inflammation and endothelial dysfunction leading to particularly severe hypoxemia. We hypothesized that an impaired hypoxic pulmonary vasoconstriction aggravates hypoxemia. The objective of the study was to test the effect of two pulmonary vasoactive drugs on patient oxygenation.Methods: Observational, single-center, open-label study in one intensive care unit (ICU) of the Paris area, realized in April 2020. Eligible patients had coronavirus disease 2019 (COVID-19) and moderate to severe ARDS [arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) <200 mmHg] despite conventional protective ventilation. Exclusion criteria included pulmonary artery hypertension defined by a pulmonary artery systolic pressure (PAPs) >45 mmHg. The assessment of oxygenation was based on PaO2/FiO2 at (1) baseline, then after (2) 30 min of inhaled nitric oxide (iNO) 10 ppm alone, then (3) 30 min combination of iNO + almitrine infusion 8 μg/kg/min, then (4) 30 min of almitrine infusion alone.Results: Among 20 patients requiring mechanical ventilation during the study period, 12 met the inclusion criteria. Baseline PaO2/FiO2 was 146 ± 48 mmHg. When iNO was combined with almitrine, PaO2/FiO2 rose to 255 ± 90 mmHg (+80 ± 49%, p = 0.005), also after almitrine alone: 238 ± 98 mmHg (+67 ± 75%, p = 0.02), but not after iNO alone: 185 ± 73 mmHg (+30 ± 5%, p = 0.49). No adverse events related to almitrine infusion or iNO was observed.Conclusion: Combining iNO and infused almitrine improved the short-term oxygenation in patients with COVID-19-related ARDS. This combination may be of interest when first-line therapies fail to restore adequate oxygenation. These findings argue for an impaired pulmonary hypoxic vasoconstriction in these patients. |
| first_indexed | 2024-12-17T00:08:23Z |
| format | Article |
| id | doaj.art-e5ec67d3e66f45ac9b26f1fc1b9ac3f4 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-17T00:08:23Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-e5ec67d3e66f45ac9b26f1fc1b9ac3f42022-12-21T22:10:53ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-07-01810.3389/fmed.2021.655763655763Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19Driss LaghlamGhilas RahoualJulien MalvyPhilippe EstagnasiéAlain BrussetPierre SquaraIntroduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is manifested by an acute respiratory distress syndrome (ARDS) with intense inflammation and endothelial dysfunction leading to particularly severe hypoxemia. We hypothesized that an impaired hypoxic pulmonary vasoconstriction aggravates hypoxemia. The objective of the study was to test the effect of two pulmonary vasoactive drugs on patient oxygenation.Methods: Observational, single-center, open-label study in one intensive care unit (ICU) of the Paris area, realized in April 2020. Eligible patients had coronavirus disease 2019 (COVID-19) and moderate to severe ARDS [arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) <200 mmHg] despite conventional protective ventilation. Exclusion criteria included pulmonary artery hypertension defined by a pulmonary artery systolic pressure (PAPs) >45 mmHg. The assessment of oxygenation was based on PaO2/FiO2 at (1) baseline, then after (2) 30 min of inhaled nitric oxide (iNO) 10 ppm alone, then (3) 30 min combination of iNO + almitrine infusion 8 μg/kg/min, then (4) 30 min of almitrine infusion alone.Results: Among 20 patients requiring mechanical ventilation during the study period, 12 met the inclusion criteria. Baseline PaO2/FiO2 was 146 ± 48 mmHg. When iNO was combined with almitrine, PaO2/FiO2 rose to 255 ± 90 mmHg (+80 ± 49%, p = 0.005), also after almitrine alone: 238 ± 98 mmHg (+67 ± 75%, p = 0.02), but not after iNO alone: 185 ± 73 mmHg (+30 ± 5%, p = 0.49). No adverse events related to almitrine infusion or iNO was observed.Conclusion: Combining iNO and infused almitrine improved the short-term oxygenation in patients with COVID-19-related ARDS. This combination may be of interest when first-line therapies fail to restore adequate oxygenation. These findings argue for an impaired pulmonary hypoxic vasoconstriction in these patients.https://www.frontiersin.org/articles/10.3389/fmed.2021.655763/fullacute respiratory distress syndromealmitrinenitric oxidemechanical ventilationCOVID-19 |
| spellingShingle | Driss Laghlam Ghilas Rahoual Julien Malvy Philippe Estagnasié Alain Brusset Pierre Squara Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 Frontiers in Medicine acute respiratory distress syndrome almitrine nitric oxide mechanical ventilation COVID-19 |
| title | Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 |
| title_full | Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 |
| title_fullStr | Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 |
| title_full_unstemmed | Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 |
| title_short | Use of Almitrine and Inhaled Nitric Oxide in ARDS Due to COVID-19 |
| title_sort | use of almitrine and inhaled nitric oxide in ards due to covid 19 |
| topic | acute respiratory distress syndrome almitrine nitric oxide mechanical ventilation COVID-19 |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.655763/full |
| work_keys_str_mv | AT drisslaghlam useofalmitrineandinhalednitricoxideinardsduetocovid19 AT ghilasrahoual useofalmitrineandinhalednitricoxideinardsduetocovid19 AT julienmalvy useofalmitrineandinhalednitricoxideinardsduetocovid19 AT philippeestagnasie useofalmitrineandinhalednitricoxideinardsduetocovid19 AT alainbrusset useofalmitrineandinhalednitricoxideinardsduetocovid19 AT pierresquara useofalmitrineandinhalednitricoxideinardsduetocovid19 |