RT Journal Article
SR Electronic
T1 Potential for personalised application of inhaled nitric oxide in Covid-19 pneumonia
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA3325
DO 10.1183/13993003.congress-2021.PA3325
VO 58
IS suppl 65
A1 Benjamin Garfield
A1 Charles Mcfadyen
A1 Charlotte Briar
A1 Colm Mccabe
A1 Stefan Ledot
A1 Melissa Baldwin
A1 Katerina Vlachou
A1 Susanna Price
A1 S John Wort
A1 Brijesh Patel
A1 Laura Price
YR 2021
UL http://erj.ersjournals.com/content/58/suppl_65/PA3325.abstract
AB Inhaled nitric oxide (iNO) has been reported as a rescue strategy in ARDS. A potential role for iNO is proposed in COVID-19, especially given the ‘pulmonary vascular’ phenotype and right ventricular (RV) dysfunction increasingly apparent in this disease.Patients admitted to a tertiary respiratory failure centre in the UK receiving iNO with at least moderate ARDS in March-May 2020 were studied. Measurements to calculate PaO2/FiO2 ratio, oxygenation index (OI), and dead space fraction (based on the Bohr equation) were obtained before and after initiating iNO from ventilator data.Thirty-five consecutive patients (20% female) were treated with 20 ppm iNO, for 146.4 (80.8) h. PaO2/FiO2 ratio increased from baseline (13.6 [3.9] vs 17.4 [5.5] kPa at 24 hours, p<0.001). OI and dead space fraction were significantly reduced (Figure 1).According to a pre-defined improvement in PaO2/FiO2 ratio by at least 1.33 kPa, 23 patients [65.7%] responded to iNO at 24 h. Responders had higher baseline brain natriuretic peptide (p=0.023) and troponin (p=0.015).The 30 day mortality after starting iNO was 17/35 (48.5%).In this cohort of patients with at least moderately severe COVID-ARDS, iNO at 20 ppm improved oxygenation and ventilatory efficiency. We were able to differentiate responders from non-responders on the basis of higher levels of cardiac biomarkers, suggesting a putative mechanism.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA3325.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).