Diana Lemieux, BCCCP, PharmD
Clinical Pharmacy Specialist
Yale New Haven Hospital, United States
Disclosure information not submitted.
Ashley West, BCCCP, BCPS, PharmD
Yale New Haven Health
New Haven, Connecticut
Disclosure information not submitted.
Ethan Bernstein, MD
Clinical Fellow
Yale University School of Medicine, United States
Disclosure information not submitted.
Cynthia Cheung, PharmD
Clinical Pharmacist
Yale New Haven Hospital, United States
Disclosure information not submitted.
Allison Mogensen, PharmD
Clinical Pharmacist
Yale New Haven Hospital, United States
Disclosure information not submitted.
Michele Moura, PharmD, BCPS, BCCCP
Clinical Pharmacist
Yale New Haven Hospital, United States
Disclosure information not submitted.
Ginger Rouse, BCCCP, PharmD, BCPS,
Clinical Pharmacy Specialist II, Medical Intensive Care
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Steven Lemieux, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
VA Connecticut Healthcare System, United States
Disclosure information not submitted.
Title: Comparison of Inhaled Nitric Oxide and Aerosolized Epoprostenol in COVID-19 Related ARDS
INTRODUCTION: Previous studies have shown that inhaled pulmonary vasodilators can improve oxygenation in patients with acute respiratory distress syndrome (ARDS). It is unclear whether inhaled nitric oxide (iNO) or aerosolized epoprostenol (aEPO) is superior in patients with ARDS from Coronavirus Disease-2019 (COVID-19). iNO may possess antiviral properties and a small in vitro study demonstrated inhibition of SARS-CoV replication. Patients with COVID-19 are predisposed to venous thromboembolism and aEPO may exert antithrombic effects. The aim of this study was to compare the safety and efficacy of iNO versus aEPO in COVID-19 patients with ARDS.
Methods: This was a single-center, retrospective chart review, which included patients hospitalized with COVID-19 ARDS between March 1, 2020 and March 1, 2021 who were treated with an inhaled pulmonary vasodilator. The primary outcome was mechanical ventilator (MV)-free days and secondary outcomes included in-hospital mortality, intensive care unit (ICU) length of stay (LOS), hospital LOS, initiation of extracorporeal membrane oxygenation (ECMO), and change in plateau pressures at 1, 4, 6, and 12 hours after pulmonary vasodilator initiation. Safety outcomes included incidence of bleeding, methemoglobinemia, and thrombocytopenia.
Results: A total of 68 patients were included for analysis; 10 patients in the iNO group and 58 patients in the aEPO group. There were no differences in baseline characteristics between the two groups. There was no significant difference in MV-free days (0 days vs 1.5 days ± 4.5, p=0.25) between iNO and aEPO. There was also no difference between iNO and aEPO in ICU LOS (12 days [IQR, 10 – 20] vs 19.5 days [IQR, 14 – 27], p=0.52), hospital LOS (16.5 days [IQR, 11.5 – 25.5] vs 24 days [IQR, 17 – 32.5], p=0.117), initiation of ECMO [0 patients versus 2 patients (3.4%), p = 1], and in-hospital mortality (100% vs 94.8%, p=1). There were no differences in the change in plateau pressures between any of time points. No differences were found in the incidence of bleeding, methemoglobinemia, and thrombocytopenia
Conclusion: Neither iNO nor aEPO is superior for the treatment of COVID-19 related ARDS. Substantial cost-savings may be incurred through use of aEPO rather than iNO in these patients. Larger studies are needed to confirm these findings.