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Inhaled Nitric Oxide ReDuce postoperatIve pulmoNAry complicaTions in patiEnts with recent COVID-19 infection

Ziyu Zheng^1,2, Lini Wang^1,2, Shuxiu Wang¹

¹Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China.

|March 14, 2024

Abstract

Background:

A history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate the rates of early postoperative mortality, intensive care unit (ICU) admission and prolong the length of ICU and/or hospital stays. Consequently, it is crucial to develop perioperative management strategies that can mitigate these increased risks in surgical patients who have recently been infected with SARS-CoV-2. Accumulating evidence suggests that nitric oxide (NO) inhalation might be effective in treating COVID-19. NO functions in COVID-19 by promoting vasodilation, anticoagulation, anti-inflammatory and antiviral effects. Therefore, our study hypothesises that the perioperative use of NO can effectively reduce PPCs in patients with recent SARS-CoV-2 infection.

Method And Analysis:

A prospective, double-blind, single-centre, randomised controlled trial is proposed. The trial aims to include participants who are planning to undergo surgery with general anaesthesia and have been recently infected with SARS-CoV-2 (within 7 weeks). Stratified allocation of eligible patients will be performed at a 1:1 ratio based on the predicted risk of PPCs using the Assess Respiratory Risk in Surgical Patients in Catalonia risk index and the time interval between infection and surgery.The primary outcome of the study will be the presence of PPCs within the first 7 days following surgery, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis. The primary outcome will be reported as counts (percentage) and will be compared using a two-proportion χ² test. The common effect across all primary components will be estimated using a multiple generalised linear model.

Ethics And Dissemination:

The trial is approved by the Institutional Review Board of Xijing Hospital (KY20232058-F1). The findings, including positive, negative and inconclusive results, will be published in scientific journals with peer-review processes.

Trial Registration Number:

NCT05721144.

Insights

Recent SARS-CoV-2 infection increases surgical patients' risk of pulmonary complications. This study investigates if perioperative nitric oxide (NO) inhalation can reduce these postoperative pulmonary complications (PPCs) in patients with recent COVID-19.

Area of Science:

Medical Research
Pulmonology
Anesthesiology

Background:

A history of SARS-CoV-2 infection is linked to a higher risk of postoperative pulmonary complications (PPCs).
PPCs can lead to increased mortality, ICU admission, and prolonged hospital stays.
Effective perioperative strategies are needed for surgical patients with recent SARS-CoV-2 infection.

Purpose of the Study:

To investigate the efficacy of perioperative nitric oxide (NO) inhalation in reducing PPCs.
To mitigate the increased risks associated with recent SARS-CoV-2 infection in surgical patients.
To explore the potential benefits of NO, including vasodilation, anticoagulation, and anti-inflammatory effects.

Main Methods:

A prospective, double-blind, randomized controlled trial.
Inclusion of patients undergoing surgery with general anesthesia and recent SARS-CoV-2 infection (within 7 weeks).
Stratified allocation (1:1) based on PPC risk index and time since infection; primary outcome: PPCs within 7 days post-surgery.

Main Results:

This section is not applicable as the study is prospective and results are not yet available.

Conclusions:

This study hypothesizes that perioperative nitric oxide (NO) can effectively reduce PPCs in patients with recent SARS-CoV-2 infection.
Further research is needed to confirm the findings and establish NO as a standard treatment.
Publication of findings, regardless of outcome, is planned.

Read full analysis

Keywords:

ANAESTHETICS COVID-19 Prognosis SURGERY

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