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Impact of Inhaled Nitric Oxide (iNO) on the Outcome of COVID-19 Associated ARDS

Sandra Emily Stoll1,2, Bernd W Böttiger1, Fabian Dusse1

  • 1Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.

Journal of Clinical Medicine
|October 16, 2024
PubMed

Insights

Inhaled nitric oxide (iNO) improved oxygenation in some patients with COVID-19 ARDS but did not affect inflammatory markers or thrombotic events. It was associated with longer mechanical ventilation duration.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Inhaled nitric oxide (iNO) is known to improve oxygenation in acute respiratory distress syndrome (ARDS).
  • iNO possesses anti-inflammatory and antithrombotic properties and may inhibit viral replication.
  • COVID-19 associated ARDS (CARDS) presents unique challenges in critical care management.

Purpose of the Study:

  • To evaluate the impact of iNO on oxygenation in CARDS patients.
  • To assess the effect of iNO on inflammatory markers and thrombotic events.
  • To determine the influence of iNO on the duration of mechanical ventilation (MV) during ICU stay.

Main Methods:

  • Retrospective, observational, monocentric study design.
  • Comparison of adult ventilated CARDS patients receiving iNO (15 ppm) versus those not receiving iNO.
  • Analysis of oxygenation, inflammatory markers, and thrombotic events during ICU stay.

Main Results:

  • Oxygenation improved in iNO-responders (7/19 patients).
  • No significant difference was observed in inflammatory markers or the rate of thrombotic events between groups.
  • A longer duration of mechanical ventilation was associated with iNO treatment.

Conclusions:

  • iNO can improve oxygenation in a subset of CARDS patients (responders).
  • iNO did not demonstrate efficacy in reducing inflammatory markers or thrombotic events in this cohort.
  • The use of iNO in CARDS was linked to an increased duration of mechanical ventilation.

Keywords:
ARDSCOVID-19 associated ARDSNOiNOinhaled nitric oxide

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