A Comparison of Inhaled Epoprostenol in Patients With Acute Respiratory Distress Syndrome and COVID-19-Associated Acute Respiratory Distress Syndrome

Abstract

IntroductionAcute respiratory distress syndrome (ARDS) and coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (CARDS) are both characterized by non-cardiogenic pulmonary edema and severe hypoxemia that leads to a high percentage of patients suffering in-hospital mortality. Mechanistically, inhaled epoprostenol (iEPO) has shown a role in the treatment of ARDS and CARDS but little data are available directly comparing the two disease processes. Due to the lack of evidence of iEPO in ARDS and CARDS, the authors sought to compare the pulmonary effects of iEPO for mechanically ventilated patients with CARDS against a case match control of those with ARDS. MethodsA retrospective cohort of all patients receiving iEPO between January 1, 2020, and February 22, 2022, was reviewed. Patients with ARDS were case-matched in a 2:1 allocation ratio of CARDS to ARDS by the number of medical comorbidities and age +/-5 years. Clinical data collected included patient demographics, laboratory values, ventilator settings, length of hospitalization, and 28-day mortality. Comparisons of the effectiveness of iEPO between ARDS and CARDS were conducted using the chi-squared statistic for categorical variables and the Mann-Whitney statistic for continuous variables. ResultsA total of 72 patients were included in the final analysis, with 24 having ARDS and 48 CARDS. The number of medical comorbidities was no different for patients with ARDS or CARDs (p = 0.18), though the frequency of patients diagnosed with coronary artery disease (p=0.007), congestive heart failure (p=0.003), chronic obstructive pulmonary disease (p=0.004), and pulmonary hypertension (p=0.004) did vary between the two groups. A moderate but non-significant difference in pre-iEPO partial pressure of oxygen (PaO 2 )/fraction of inspired oxygen (FiO 2 ) ratio was noted between the groups (0.74 vs 0.65; p=0.33). Following iEPO treatment, patients with ARDS showed a greater PaO 2 /FiO 2 ratio than those with CARDS (0.87 vs 0.70; p=0.02). CARDS patients who received iEPO had a longer length of stay as compared to those with ARDS (17.5 vs 12.5 days; p=0.01). However, no difference was noted in 28-day mortality between the two groups (14 vs 34; p=0.29). ConclusionIn this small sample from a single community hospital, a statistically significant improvement in the PaO 2 /FiO 2 ratio was noted for both those with ARDS and CARDS. However, those with CARDS who were given iEPO had a longer length of stay without a significant difference in mortality as compared to those with traditional ARDS.

A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome

“…66 Robinson et al performed a retrospective cohort analysis of critically ill patients with COVID-19-associated ARDS and non-COVID-19 ARDS in a 2:1 ratio. 67 All patients received iEPO and resulted in a statistically significant greater increase in P/F ratio in patients with non-COVID-19 ARDS compared with those with COVID-19-associated ARDS. 67 Patients with COVID-19-associated ARDS also had a statistically significant longer length of stay (LOS) but no statistically significant difference in 28-day mortality.…”

“…67 All patients received iEPO and resulted in a statistically significant greater increase in P/F ratio in patients with non-COVID-19 ARDS compared with those with COVID-19-associated ARDS. 67 Patients with COVID-19-associated ARDS also had a statistically significant longer length of stay (LOS) but no statistically significant difference in 28-day mortality. 67 Nguyen et al conducted a retrospective, observational, cohort study of patients with COVID-19-associated ARDS who received iEPO and compared with those patients with COVID-19-associated ARDS not receiving iEPO.…”

“…67 Patients with COVID-19-associated ARDS also had a statistically significant longer length of stay (LOS) but no statistically significant difference in 28-day mortality. 67…”

“…67 Patients with COVID-19-associated ARDS also had a statistically significant longer length of stay (LOS) but no statistically significant difference in 28-day mortality. 67 Nguyen et al conducted a retrospective, observational, cohort study of patients with COVID-19-associated ARDS who received iEPO and compared with those patients with COVID-19-associated ARDS not receiving iEPO. 63 The use of iEPO resulted in a nonstatistically significant increase in ventilator-free days.…”