Omar Mahmoud
Fellow, Division of Pulmonary and Critical Care Medicine
University of Maryland Medical Center, United States
Disclosure information not submitted.
Edith Robin, n/a
Resident, Division of Internal Medicine
Mount Sinai Morningside & Mount Sinai West Hospitals, United States
Disclosure information not submitted.
Dishant Shah, n/a
Resident, Division of Internal Medicine
Mount Sinai Morningside & Mount Sinai West Hospitals, United States
Disclosure information not submitted.
Elizabeth Zipf
Mount Sinai St Luke's & Mount Sinai Roosevelt Hospital Center
New York, NY
Disclosure information not submitted.
Maria Riego, MD
Resident, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
James Salonia, MD,
Assistant Professor, Division of Pulmonary and Critical Care Medicine
n/a, United States
Disclosure information not submitted.
Title: Use of Inhaled Vasodilators in Non-Intubated Patients with Acute Respiratory Failure due to COVID-19
Introduction: Inhaled pulmonary vasodilators have been used as a rescue therapy for refractory hypoxemia in mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), but have not shown a difference in mortality outcomes. There is paucity of data in patients with ARDS due to COVID-19 infection and no data with the use of inhaled vasodilators with non invasive modes of ventilation. We aimed to assess the clinical and physiological outcomes of administering Inhaled Epoprostenol (iEpo) to patients with Acute Hypoxemic Respiratory Failure (AHRF) due to COVID-19 requiring High Flow Nasal Cannula (HFNC).
Methods: We present a case series of 16 patients with AHRF due to COVID-19 who were administered iEpo for refractory hypoxemia requiring 100% FiO2 on HFNC. Only patients who were full code at admission were included in our study. We retrospectively reviewed the medical records of these patients. The primary outcome studied was the requirement for escalation to mechanical ventilation. Secondary outcomes include mortality, change in oxygen saturation, respiratory rate or FiO2 requirements.
Results: Ten of 16 patients required escalation to mechanical ventilation. Six (37.5%) patients were successfully weaned off HFNC after starting iEpo. Mortality was 50% (8/16). There was a significant improvement in the oxygen saturation (92.12% ± 4.03 vs 94.31 ± 5.45; p 0.026) and FiO2 requirements (100% ± 0 vs 82.5 ± 21.83;p 0.003) after 48 hours of iEpo. No difference was noticed in the respiratory rate (24.31 ± 6.58 vs 24.37 ± 6.87; p 0.976) or the pCO2 (40.05 ± 6.51 vs 38.32 ± 9.206; p 0.381)with iEpo. Patients were started on iEpo on an average of 4.5 days (3.5-12 days) after hospital admission. Multivariate analysis showed that for every 1 day delay in starting iEpo, chances of being intubated increase by 4.5% (Coef 0.045 (0.006-0.085) p 0.029).
Discussion: Our case series suggests that early use of iEpo with HFNC may reduce the need for invasive mechanical ventilation. We are currently performing a large retrospective study in the Mount Sinai Health System to assess the effect of iEpo with non invasive methods of ventilation.