Related Experiment Video
Updated: Sep 2, 2025
05:46
A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
5.2K
Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis
Waleed Khokher1, Saif-Eddin Malhas1, Azizullah Beran1
1Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
Journal of Intensive Care Medicine
|August 2, 2022
Summary
Inhaled pulmonary vasodilators (IPVD) may improve oxygenation in COVID-19 acute respiratory distress syndrome (ARDS) patients. However, this meta-analysis found no significant reduction in mortality compared to standard therapy alone.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Infectious Diseases
Background:
- Inhaled pulmonary vasodilators (IPVD) have demonstrated efficacy in non-COVID-19 acute respiratory distress syndrome (ARDS).
- IPVD improve oxygenation by increasing the partial pressure of oxygen in arterial blood (PaO2) and PaO2/FiO2 (P/F) ratios.
- The utility of IPVD in COVID-19 ARDS remains uncertain.
Purpose of the Study:
- To evaluate the role and efficacy of IPVD in patients with COVID-19 ARDS.
- To assess the impact of IPVD on oxygenation, mortality, and other clinical outcomes.
Main Methods:
- A comprehensive meta-analysis of published literature from PubMed, Embase, Web of Science, and Cochrane Library databases up to April 22, 2022.
- Included 1-arm meta-analysis of retrospective studies and case series (613 patients) and 2-arm meta-analysis of comparative studies (640 patients).
- Primary outcomes: change in P/F ratio (1-arm) and mortality (2-arm). Secondary outcomes included positive end-expiratory pressure (PEEP), lung compliance, endotracheal intubation, and hospital length of stay (LOS).
Main Results:
- The 1-arm meta-analysis showed a significant improvement in P/F ratios post-IPVD, but no significant changes in PEEP or lung compliance.
- The 2-arm meta-analysis revealed similar mortality rates, need for endotracheal intubation, and hospital LOS between IPVD and standard therapy groups.
- Overall, IPVD demonstrated a positive effect on oxygenation but did not translate to improved survival or reduced resource utilization.
Conclusions:
- While IPVD may enhance oxygenation in COVID-19 ARDS, current evidence does not support a significant benefit in reducing mortality compared to standard care.
- Further high-quality randomized controlled trials are necessary to definitively establish the clinical effectiveness of IPVD in this patient population.
- The findings suggest a potential role for IPVD in supportive oxygenation management but highlight the need for more robust clinical validation.
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
287
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
287
01:23Antihypertensive Drugs: Vasodilators
628
Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
628
01:28Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
240
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
240
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
249
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
249
01:30Pulmonary Hypertension: Classification and Pathogenesis
275
Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
There are various classifications for PH, each relating to different underlying causes and also...
275
01:20COPD: Pathogenesis and Clinical Features
485
Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that progressively worsen over time, including chronic bronchitis and emphysema. This cluster of diseases collectively leads to a gradual and irreversible decline in lung function over time.
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
485