Effect of almitrine bismesylate and inhaled nitric oxide on oxygenation in COVID-19 acute respiratory distress syndrome

Cardinale, Michaël; Esnault, Pierre; Cotté, Jean; Cungi, Pierre Julien; Goutorbe, Philippe

doi:10.1016/j.accpm.2020.05.014

Cited by 23 publications

(20 citation statements)

References 4 publications

(5 reference statements)

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“…Possible benefits of inhaled nitric oxide therapy have been reported in case studies of people with COVID-19, including "home therapy" (296,306), and via portable systems developed for potential use in out-patient settings [reviewed by (285)]. In small clinical studies, inhaled nitric oxide (at doses of 10-25 ppm) did not significantly modify the PaO 2 /FiO 2 ratio (a measure of oxygenation) in ventilated patients with COVID-19, who had refractory hypoxemia (307)(308)(309). At a slightly higher dose, inhaled nitric oxide (starting at 30 ppm) improved oxygenation of 21 of 39 nonintubated individuals with COVID-19 (310).…”

Section: Clinical Trials Assessing Nitric Oxidementioning

confidence: 99%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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During the COVID-19 (coronavirus disease of 2019) pandemic, researchers have been seeking low-cost and accessible means of providing protection from its harms, particularly for at-risk individuals such as those with cardiovascular disease, diabetes and obesity. One possible way is via safe sun exposure, and/or dietary supplementation with induced beneficial mediators (e.g., vitamin D). In this narrative review, we provide rationale and updated evidence on the potential benefits and harms of sun exposure and ultraviolet (UV) light that may impact COVID-19. We review recent studies that provide new evidence for any benefits (or otherwise) of UV light, sun exposure, and the induced mediators, vitamin D and nitric oxide, and their potential to modulate morbidity and mortality induced by infection with SARS-CoV-2 (severe acute respiratory disease coronavirus-2). We identified substantial interest in this research area, with many commentaries and reviews already published; however, most of these have focused on vitamin D, with less consideration of UV light (or sun exposure) or other mediators such as nitric oxide. Data collected to-date suggest that ambient levels of both UVA and UVB may be beneficial for reducing severity or mortality due to COVID-19, with some inconsistent findings. Currently unresolved are the nature of the associations between blood 25-hydroxyvitamin D and COVID-19 measures, with more prospective data needed that better consider lifestyle factors, such as physical activity and personal sun exposure levels. Another short-coming has been a lack of measurement of sun exposure, and its potential to influence COVID-19 outcomes. We also discuss possible mechanisms by which sun exposure, UV light and induced mediators could affect COVID-19 morbidity and mortality, by focusing on likely effects on viral pathogenesis, immunity and inflammation, and potential cardiometabolic protective mechanisms. Finally, we explore potential issues including the impacts of exposure to high dose UV radiation on COVID-19 and vaccination, and effective and safe doses for vitamin D supplementation.

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Section: Clinical Trials Assessing Nitric Oxidementioning

confidence: 99%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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“…A small study that examined 39 spontaneously breathing patients with COVID-19 who underwent therapy with iNO showed that more than half did not require mechanical ventilation after treatment [ 49 ]. However, in another small study, the use of NO or almitrine bismesylate, or both did not improve oxygenation in moderate to severe CARDS [ 50 ].…”

Section: Inhaled Vasodilatorsmentioning

confidence: 99%

Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review

Matera

Rogliani

Calzetta

et al. 2020

Respiratory Medicine

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Coronavirus disease 2019 (COVID-19) is highly infectious. It has been highlighted that if not expertly and individually managed with consideration of the vasocentric features, a COVID-19 patient with an acute respiratory distress syndrome (CARDS) may eventually develop multiorgan failure. Unfortunately, there is still no definite drug for CARDS that is capable of reducing either short-term or long-term mortality and no specific treatments for COVID-19 exist right now. In this narrative review, based on a selective literature search in EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science, and Google Scholar and ClinicalTrials.gov , we have examined the emerging evidence on the possible treatment of CARDS. Although numerous pharmacologic therapies to improve clinical outcomes in CARDS have been studied also in clinical trials, none have shown efficacy and there is great uncertainty about their effectiveness. There is still no recommendation for the therapeutic use of any specific agent to treat CARDS because no drugs are validated to have significant efficacy in clinical treatment of COVID-19 patients in large-scale trials. However, there exist a number of drugs that may be useful at least in some patients. The real challenge now is to link the right patient to the right treatment.

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“…Cardinale et al report a retrospective analysis of 20 consecutive prone patients in severe COVID-19 ARDS (median PaO 2 /FiO 2 at 106 mmHg) and already on ventilation for one week (late phase of severe ARDS) [11]. Ten patients were treated with NO inhalation (between 10 to 20 ppm), 13 with almitrine infusion (loading dose of 0.5 mg/Kg over 30 minutes), and 7 with a combined treatment.…”

Section: Editorialmentioning

confidence: 99%

“…The gravitational posture potentiates HPV induced by an almitrine infusion, which acts to divert pulmonary blood flow away from poorly ventilated alveoli toward well-ventilated areas. However, regrettably in the second investigation [11], there was insufficient echocardiographic assessment needed to exclude a patent foramen ovale. Indeed, the haemodynamic effects of almitrine on pulmonary arterial pressure and right ventricular pressures [15] may induce an intracardiac shunt that offsets and abolishes the benefit of the drug on blood oxygenation.…”

Section: Editorialmentioning

confidence: 99%

Treating hypoxemic COVID-19 “ARDS” patients with almitrine: The earlier the better?

Bendjelid

Raphaël

Düring

2020

Anaesthesia Critical Care & Pain Medicine

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Effect of almitrine bismesylate and inhaled nitric oxide on oxygenation in COVID-19 acute respiratory distress syndrome

Cited by 23 publications

References 4 publications

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review

Treating hypoxemic COVID-19 “ARDS” patients with almitrine: The earlier the better?

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