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Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study

BACKGROUND: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill...

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Autores principales: Al Sulaiman, Khalid, Korayem, Ghazwa B., Altebainawi, Ali F., Al Harbi, Shmeylan, Alissa, Abdulrahman, Alharthi, Abdullah, Kensara, Raed, Alfahed, Amjaad, Vishwakarma, Ramesh, Al Haji, Hussain, Almohaimid, Naif, Al Zumai, Omar, Alrubayan, Fahad, Asiri, Abdulmajid, Alkahtani, Nasser, Alolayan, Abdulaziz, Alsohimi, Samiah, Melibari, Nawal, Almagthali, Alaa, Aljahdali, Seba, Alenazi, Abeer A., Alsaeedi, Alawi S., Al Ghamdi, Ghassan, Al Faris, Omar, Alqahtani, Joud, Al Qahtani, Jalal, Alshammari, Khalid A., Alshammari, Khalil I., Aljuhani, Ohoud
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9527729/
https://www.ncbi.nlm.nih.gov/pubmed/36192801
http://dx.doi.org/10.1186/s13054-022-04158-y
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author Al Sulaiman, Khalid
Korayem, Ghazwa B.
Altebainawi, Ali F.
Al Harbi, Shmeylan
Alissa, Abdulrahman
Alharthi, Abdullah
Kensara, Raed
Alfahed, Amjaad
Vishwakarma, Ramesh
Al Haji, Hussain
Almohaimid, Naif
Al Zumai, Omar
Alrubayan, Fahad
Asiri, Abdulmajid
Alkahtani, Nasser
Alolayan, Abdulaziz
Alsohimi, Samiah
Melibari, Nawal
Almagthali, Alaa
Aljahdali, Seba
Alenazi, Abeer A.
Alsaeedi, Alawi S.
Al Ghamdi, Ghassan
Al Faris, Omar
Alqahtani, Joud
Al Qahtani, Jalal
Alshammari, Khalid A.
Alshammari, Khalil I.
Aljuhani, Ohoud
author_facet Al Sulaiman, Khalid
Korayem, Ghazwa B.
Altebainawi, Ali F.
Al Harbi, Shmeylan
Alissa, Abdulrahman
Alharthi, Abdullah
Kensara, Raed
Alfahed, Amjaad
Vishwakarma, Ramesh
Al Haji, Hussain
Almohaimid, Naif
Al Zumai, Omar
Alrubayan, Fahad
Asiri, Abdulmajid
Alkahtani, Nasser
Alolayan, Abdulaziz
Alsohimi, Samiah
Melibari, Nawal
Almagthali, Alaa
Aljahdali, Seba
Alenazi, Abeer A.
Alsaeedi, Alawi S.
Al Ghamdi, Ghassan
Al Faris, Omar
Alqahtani, Joud
Al Qahtani, Jalal
Alshammari, Khalid A.
Alshammari, Khalil I.
Aljuhani, Ohoud
author_sort Al Sulaiman, Khalid
collection PubMed
description BACKGROUND: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. METHODS: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. RESULTS: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO(2), FiO(2) requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and  ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). CONCLUSION: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04158-y.
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spelling pubmed-95277292022-10-03 Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study Al Sulaiman, Khalid Korayem, Ghazwa B. Altebainawi, Ali F. Al Harbi, Shmeylan Alissa, Abdulrahman Alharthi, Abdullah Kensara, Raed Alfahed, Amjaad Vishwakarma, Ramesh Al Haji, Hussain Almohaimid, Naif Al Zumai, Omar Alrubayan, Fahad Asiri, Abdulmajid Alkahtani, Nasser Alolayan, Abdulaziz Alsohimi, Samiah Melibari, Nawal Almagthali, Alaa Aljahdali, Seba Alenazi, Abeer A. Alsaeedi, Alawi S. Al Ghamdi, Ghassan Al Faris, Omar Alqahtani, Joud Al Qahtani, Jalal Alshammari, Khalid A. Alshammari, Khalil I. Aljuhani, Ohoud Crit Care Research BACKGROUND: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. METHODS: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. RESULTS: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO(2), FiO(2) requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and  ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). CONCLUSION: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04158-y. BioMed Central 2022-10-03 /pmc/articles/PMC9527729/ /pubmed/36192801 http://dx.doi.org/10.1186/s13054-022-04158-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Al Sulaiman, Khalid
Korayem, Ghazwa B.
Altebainawi, Ali F.
Al Harbi, Shmeylan
Alissa, Abdulrahman
Alharthi, Abdullah
Kensara, Raed
Alfahed, Amjaad
Vishwakarma, Ramesh
Al Haji, Hussain
Almohaimid, Naif
Al Zumai, Omar
Alrubayan, Fahad
Asiri, Abdulmajid
Alkahtani, Nasser
Alolayan, Abdulaziz
Alsohimi, Samiah
Melibari, Nawal
Almagthali, Alaa
Aljahdali, Seba
Alenazi, Abeer A.
Alsaeedi, Alawi S.
Al Ghamdi, Ghassan
Al Faris, Omar
Alqahtani, Joud
Al Qahtani, Jalal
Alshammari, Khalid A.
Alshammari, Khalil I.
Aljuhani, Ohoud
Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title_full Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title_fullStr Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title_full_unstemmed Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title_short Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study
title_sort evaluation of inhaled nitric oxide (ino) treatment for moderate-to-severe ards in critically ill patients with covid-19: a multicenter cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9527729/
https://www.ncbi.nlm.nih.gov/pubmed/36192801
http://dx.doi.org/10.1186/s13054-022-04158-y
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