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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2023

Open Access 01-12-2023 | Acute Respiratory Distress-Syndrome | Research

Inhaled nitric oxide in patients with acute respiratory distress syndrome caused by COVID-19: treatment modalities, clinical response, and outcomes

Authors: Armand Mekontso Dessap, Laurent Papazian, Manuella Schaller, Saad Nseir, Bruno Megarbane, Luc Haudebourg, Jean-François Timsit, Jean-Louis Teboul, Khaldoun Kuteifan, Marc Gainnier, Michel Slama, Patrick Houeto, Laurent Lecourt, Alain Mercat, Antoine Vieillard-Baron

Published in: Annals of Intensive Care | Issue 1/2023

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Abstract

Background

Inhaled nitric oxide (iNO) has been widely used in patients with COVID-19-related acute respiratory distress syndrome (C-ARDS), though its physiological effects and outcome are debated in this setting. The objective of this cohort study was to describe the modalities of iNO use, clinical response, and outcomes in a large cohort of C-ARDS patients.

Methods

Multicentre, retrospective cohort study conducted in France.

Results

From end February to December 2020, 300 patients (22.3% female) were included, 84.5% were overweight and 69.0% had at least one comorbidity. At ICU admission, their median (IQR) age, SAPS II, and SOFA score were 66 (57–72) years, 37 (29–48), and 5 (3–8), respectively. Patients were all ventilated according to a protective ventilation strategy, and 68% were prone positioned before iNO initiation. At iNO initiation, 2%, 37%, and 61% of patients had mild, moderate, and severe ARDS, respectively. The median duration of iNO treatment was 2.8 (1.1–5.5) days with a median dosage of 10 (7–13) ppm at initiation. Responders (PaO2/FiO2 ratio improving by 20% or more) represented 45.7% of patients at 6 h from iNO initiation. The severity of ARDS was the only predictive factor associated with iNO response. Among all evaluable patients, the crude mortality was not significantly different between responders at 6 h and their counterparts. Of the 62 patients with refractory ARDS (who fulfilled extracorporeal membrane oxygenation criteria before iNO initiation), 32 (51.6%) no longer fulfilled these criteria after 6 h of iNO. The latter showed significantly lower mortality than the other half (who remained ECMO eligible), including after confounder adjustment (adjusted OR: 0.23, 95% CI 0.06, 0.89, p = 0.03).

Conclusions

Our study reports the benefits of iNO in improving arterial oxygenation in C-ARDS patients. This improvement seems more relevant in the most severe cases. In patients with ECMO criteria, an iNO-driven improvement in gas exchange was associated with better survival. These results must be confirmed in well-designed prospective studies.
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Metadata
Title
Inhaled nitric oxide in patients with acute respiratory distress syndrome caused by COVID-19: treatment modalities, clinical response, and outcomes
Authors
Armand Mekontso Dessap
Laurent Papazian
Manuella Schaller
Saad Nseir
Bruno Megarbane
Luc Haudebourg
Jean-François Timsit
Jean-Louis Teboul
Khaldoun Kuteifan
Marc Gainnier
Michel Slama
Patrick Houeto
Laurent Lecourt
Alain Mercat
Antoine Vieillard-Baron
Publication date
01-12-2023
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2023
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-023-01150-9

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