Implication of inhaled nitric oxide for the treatment of critically ill COVID‐19 patients with pulmonary hypertension

Abstract

Aims This study aims to analyse whether inhaled nitric oxide (iNO) was beneficial in the treatment of coronavirus disease 2019 (COVID‐19) patients with pulmonary hypertension. Methods and results Five critically ill COVID‐19 patients with pulmonary hypertension designated Cases 1–5 were retrospectively included. Clinical data before and after iNO treatment were serially collected and compared between patients with or without iNO treatment. The five cases experienced pulmonary artery systolic pressure (PASP) elevation (≥50 mmHg) at 30, 24, 33, 23, and 24 days after illness onset (d.a.o), respectively. Cases 1–3 received iNO treatment on the 24th, 13th, and 1st day after the first elevation of PASP, with concentrations varied from 10 to 20 ppm based on the changes of PASP and blood pressure for 10, 9, and 5 days, respectively. Upon iNO treatment, PASP of Cases 1 and 2 returned to normal on the 10th day and 1st day, and maintained between 50 and 58 mmHg in Case 3. Pa0 2 /Fi0 2 increased from 88 to 124, 51 to 118, and 146 to 244, respectively. SPO 2 increased from 91% to 97% for Case 1 and maintained a high level above 97% for Case 2. Cardiac function remained normal in the three patients after treatment. Moreover, Cases 1 and 3 survived from severe acute respiratory syndrome coronavirus 2 infection, while Case 2 finally died on the 36th day after the first elevation of PASP due to severe complications. Both cases who did not receive iNO treatment experienced a sudden decrease of PASP and Pa0 2 /Fi0 2 due to right heart failure and then died. Conclusions Inhaled nitric oxide treatment was beneficial in reducing and stabilizing the PASP and might also reduce the risk of right heart failure in COVID‐19 with pulmonary hypertension.

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

“…Elevated mean CVP (>12 mmHg) is independently associated with the occurrence of PH in patients with ARDS, thus highlighting the importance of CVP monitoring in the management of ARDS. 77 , 78 …”

“…Elevated mean CVP (>12 mmHg) is independently associated with the occurrence of PH in patients with ARDS, thus highlighting the importance of CVP monitoring in the management of ARDS. 77,78 Therefore, the long-term follow-up of cardiopulmonary function for COVID-19 survivors could become a relevant health problem in the near future, given the large number of patients infected by COVID-2019 worldwide. In this context, measuring the venous congestion in a quick and practical manner by the new VenCoM device, could be extremely useful for both the management of clinical PH following COVID-19 during the acute phase, and the monitoring of pulmonary and vascular remodeling effects after recovery to provide the best long-term management of survivors.…”

COVID-19 Induced Cardiovascular Complications and Recent Therapeutic Advances

“…Hence, PDE5Is should be advised in the basic therapeutic procedure to avert pulmonary as well as cardiovascular complications. Feng et al [25] reported the possibility of treatment with inhaled nitric oxide (iNO) in the COVID-19 patients with pulmonary hypertension. In wellventilated lung tissue, inhaled NO specifically expands the pulmonary arteries and has no impact on breath perfusion contrary to orthodox vasodilators like sildenafil or nifedipine.…”

COVID-19 Acute Respiratory Distress Syndrome and Pulmonary Embolism: A Case Report of Nebulized Nitroglycerin and Systemic Thrombolysis For Right Ventricular Failure

“…Similar agents have been studied for acute PH with RVD caused by pulmonary embolism (PE) with some benefit in the ED setting (5). Inhaled nitric oxide (iNO) is being explored as a potential treatment for ARDS caused by COVID-19 and has been shown in small studies to improve arterial oxygenation (6,7).…”