Cargando…

Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19

INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure. METHODS: We performed a multicenter cohort study of patients wit...

Descripción completa

Detalles Bibliográficos
Autores principales: Chandel, Abhimanyu, Patolia, Saloni, Ahmad, Kareem, Aryal, Shambhu, Brown, A Whitney, Sahjwani, Dhwani, Khangoora, Vikramjit, Shlobin, Oksana A, Cameron, Paula C, Singhal, Anju, Holtzclaw, Arthur W, Desai, Mehul, Nathan, Steven D, King, Christopher S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485265/
https://www.ncbi.nlm.nih.gov/pubmed/34602831
http://dx.doi.org/10.1177/11795484211047065
_version_ 1784577499147010048
author Chandel, Abhimanyu
Patolia, Saloni
Ahmad, Kareem
Aryal, Shambhu
Brown, A Whitney
Sahjwani, Dhwani
Khangoora, Vikramjit
Shlobin, Oksana A
Cameron, Paula C
Singhal, Anju
Holtzclaw, Arthur W
Desai, Mehul
Nathan, Steven D
King, Christopher S
author_facet Chandel, Abhimanyu
Patolia, Saloni
Ahmad, Kareem
Aryal, Shambhu
Brown, A Whitney
Sahjwani, Dhwani
Khangoora, Vikramjit
Shlobin, Oksana A
Cameron, Paula C
Singhal, Anju
Holtzclaw, Arthur W
Desai, Mehul
Nathan, Steven D
King, Christopher S
author_sort Chandel, Abhimanyu
collection PubMed
description INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure. METHODS: We performed a multicenter cohort study of patients with respiratory failure from COVID-19 managed with HFNC. Patients were stratified by administration of iNO via HFNC. Regression analysis was used to compare the need for mechanical ventilation and secondary endpoints including hospital mortality, length of stay, acute kidney injury, need for renal replacement therapy, and need for extracorporeal life support. RESULTS: A total of 272 patients were identified and 66 (24.3%) of these patients received iNO via HFNC for a median of 88 h (interquartile range: 44, 135). After 12 h of iNO, supplemental oxygen requirement was unchanged or increased in 52.7% of patients. Twenty-nine (43.9%) patients treated with iNO compared to 79 (38.3%) patients without iNO therapy required endotracheal intubation (P = .47). After multivariable adjustment, there was no difference in need for mechanical ventilation between groups (odds ratio: 1.53; 95% confidence interval [CI]: 0.74-3.17), however, iNO administration was associated with longer hospital length of stay (incidence rate ratio: 1.41; 95% CI: 1.31-1.51). No difference was found for mortality, acute kidney injury, need for renal replacement therapy, or need for extracorporeal life support. CONCLUSION: In patients with COVID-19 respiratory failure, iNO delivered via HFNC did not reduce oxygen requirements in the majority of patients or improve clinical outcomes. Given the observed association with increased length of stay, judicious selection of those likely to benefit from this therapy is warranted.
format Online
Article
Text
id pubmed-8485265
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-84852652021-10-02 Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19 Chandel, Abhimanyu Patolia, Saloni Ahmad, Kareem Aryal, Shambhu Brown, A Whitney Sahjwani, Dhwani Khangoora, Vikramjit Shlobin, Oksana A Cameron, Paula C Singhal, Anju Holtzclaw, Arthur W Desai, Mehul Nathan, Steven D King, Christopher S Clin Med Insights Circ Respir Pulm Med Original Research Article INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure. METHODS: We performed a multicenter cohort study of patients with respiratory failure from COVID-19 managed with HFNC. Patients were stratified by administration of iNO via HFNC. Regression analysis was used to compare the need for mechanical ventilation and secondary endpoints including hospital mortality, length of stay, acute kidney injury, need for renal replacement therapy, and need for extracorporeal life support. RESULTS: A total of 272 patients were identified and 66 (24.3%) of these patients received iNO via HFNC for a median of 88 h (interquartile range: 44, 135). After 12 h of iNO, supplemental oxygen requirement was unchanged or increased in 52.7% of patients. Twenty-nine (43.9%) patients treated with iNO compared to 79 (38.3%) patients without iNO therapy required endotracheal intubation (P = .47). After multivariable adjustment, there was no difference in need for mechanical ventilation between groups (odds ratio: 1.53; 95% confidence interval [CI]: 0.74-3.17), however, iNO administration was associated with longer hospital length of stay (incidence rate ratio: 1.41; 95% CI: 1.31-1.51). No difference was found for mortality, acute kidney injury, need for renal replacement therapy, or need for extracorporeal life support. CONCLUSION: In patients with COVID-19 respiratory failure, iNO delivered via HFNC did not reduce oxygen requirements in the majority of patients or improve clinical outcomes. Given the observed association with increased length of stay, judicious selection of those likely to benefit from this therapy is warranted. SAGE Publications 2021-09-29 /pmc/articles/PMC8485265/ /pubmed/34602831 http://dx.doi.org/10.1177/11795484211047065 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Chandel, Abhimanyu
Patolia, Saloni
Ahmad, Kareem
Aryal, Shambhu
Brown, A Whitney
Sahjwani, Dhwani
Khangoora, Vikramjit
Shlobin, Oksana A
Cameron, Paula C
Singhal, Anju
Holtzclaw, Arthur W
Desai, Mehul
Nathan, Steven D
King, Christopher S
Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title_full Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title_fullStr Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title_full_unstemmed Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title_short Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19
title_sort inhaled nitric oxide via high-flow nasal cannula in patients with acute respiratory failure related to covid-19
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485265/
https://www.ncbi.nlm.nih.gov/pubmed/34602831
http://dx.doi.org/10.1177/11795484211047065
work_keys_str_mv AT chandelabhimanyu inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT patoliasaloni inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT ahmadkareem inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT aryalshambhu inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT brownawhitney inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT sahjwanidhwani inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT khangooravikramjit inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT shlobinoksanaa inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT cameronpaulac inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT singhalanju inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT holtzclawarthurw inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT desaimehul inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT nathanstevend inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19
AT kingchristophers inhalednitricoxideviahighflownasalcannulainpatientswithacuterespiratoryfailurerelatedtocovid19