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Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients
BACKGROUND: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator and mild bronchodilator that has been shown to improve systemic oxygenation, but has rarely been administered in the Emergency Department (ED). In addition to its favorable pulmonary vascular effects, in-vitro studies report...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066706/ https://www.ncbi.nlm.nih.gov/pubmed/35623183 http://dx.doi.org/10.1016/j.ajem.2022.04.052 |
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author | Strickland, Brian Albala, Lorenzo Coffey, El Centro Carroll, Ryan W. Zapol, Warren M. Ichinose, Fumito Berra, Lorenzo Harris, N. Stuart |
author_facet | Strickland, Brian Albala, Lorenzo Coffey, El Centro Carroll, Ryan W. Zapol, Warren M. Ichinose, Fumito Berra, Lorenzo Harris, N. Stuart |
author_sort | Strickland, Brian |
collection | PubMed |
description | BACKGROUND: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator and mild bronchodilator that has been shown to improve systemic oxygenation, but has rarely been administered in the Emergency Department (ED). In addition to its favorable pulmonary vascular effects, in-vitro studies report that NO donors can inhibit replication of viruses, including SARS Coronavirus 2 (SARS-CoV-2). This study evaluated the administration of high-dose iNO by mask in spontaneously breathing emergency department (ED) patients with respiratory symptoms attributed to Coronavirus disease 2019 (COVID-19). METHODS: We designed a randomized clinical trial to determine whether 30 min of high dose iNO (250 ppm) could be safely and practically administered by emergency physicians in the ED to spontaneously-breathing patients with respiratory symptoms attributed to COVID-19. Our secondary goal was to learn if iNO could prevent the progression of mild COVID-19 to a more severe state. FINDINGS: We enrolled 47 ED patients with acute respiratory symptoms most likely due to COVID-19: 25 of 47 (53%) were randomized to the iNO treatment group; 22 of 47 (46%) to the control group (supportive care only). All patients tolerated the administration of high-dose iNO in the ED without significant complications or symptoms. Five patients receiving iNO (16%) experienced asymptomatic methemoglobinemia (MetHb) > 5%. Thirty-four of 47 (72%) subjects tested positive for SARS-CoV-2: 19 of 34 were randomized to the iNO treatment group and 15 of 34 subjects to the control group. Seven of 19 (38%) iNO patients returned to the ED, while 4 of 15 (27%) control patients did. One patient in each study arm was hospitalized: 5% in iNO treatment and 7% in controls. One patient was intubated in the iNO group. No patients in either group died. The differences between these groups were not significant. CONCLUSION: A single dose of iNO at 250 ppm was practical and not associated with any significant adverse effects when administered in the ED by emergency physicians. Local disease control led to early study closure and prevented complete testing of COVID-19 safety and treatment outcomes measures. |
format | Online Article Text |
id | pubmed-9066706 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90667062022-05-04 Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients Strickland, Brian Albala, Lorenzo Coffey, El Centro Carroll, Ryan W. Zapol, Warren M. Ichinose, Fumito Berra, Lorenzo Harris, N. Stuart Am J Emerg Med Article BACKGROUND: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator and mild bronchodilator that has been shown to improve systemic oxygenation, but has rarely been administered in the Emergency Department (ED). In addition to its favorable pulmonary vascular effects, in-vitro studies report that NO donors can inhibit replication of viruses, including SARS Coronavirus 2 (SARS-CoV-2). This study evaluated the administration of high-dose iNO by mask in spontaneously breathing emergency department (ED) patients with respiratory symptoms attributed to Coronavirus disease 2019 (COVID-19). METHODS: We designed a randomized clinical trial to determine whether 30 min of high dose iNO (250 ppm) could be safely and practically administered by emergency physicians in the ED to spontaneously-breathing patients with respiratory symptoms attributed to COVID-19. Our secondary goal was to learn if iNO could prevent the progression of mild COVID-19 to a more severe state. FINDINGS: We enrolled 47 ED patients with acute respiratory symptoms most likely due to COVID-19: 25 of 47 (53%) were randomized to the iNO treatment group; 22 of 47 (46%) to the control group (supportive care only). All patients tolerated the administration of high-dose iNO in the ED without significant complications or symptoms. Five patients receiving iNO (16%) experienced asymptomatic methemoglobinemia (MetHb) > 5%. Thirty-four of 47 (72%) subjects tested positive for SARS-CoV-2: 19 of 34 were randomized to the iNO treatment group and 15 of 34 subjects to the control group. Seven of 19 (38%) iNO patients returned to the ED, while 4 of 15 (27%) control patients did. One patient in each study arm was hospitalized: 5% in iNO treatment and 7% in controls. One patient was intubated in the iNO group. No patients in either group died. The differences between these groups were not significant. CONCLUSION: A single dose of iNO at 250 ppm was practical and not associated with any significant adverse effects when administered in the ED by emergency physicians. Local disease control led to early study closure and prevented complete testing of COVID-19 safety and treatment outcomes measures. Elsevier Inc. 2022-08 2022-05-04 /pmc/articles/PMC9066706/ /pubmed/35623183 http://dx.doi.org/10.1016/j.ajem.2022.04.052 Text en © 2022 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Strickland, Brian Albala, Lorenzo Coffey, El Centro Carroll, Ryan W. Zapol, Warren M. Ichinose, Fumito Berra, Lorenzo Harris, N. Stuart Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title | Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title_full | Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title_fullStr | Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title_full_unstemmed | Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title_short | Safety and practicality of high dose inhaled nitric oxide in emergency department COVID-19 patients |
title_sort | safety and practicality of high dose inhaled nitric oxide in emergency department covid-19 patients |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066706/ https://www.ncbi.nlm.nih.gov/pubmed/35623183 http://dx.doi.org/10.1016/j.ajem.2022.04.052 |
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