Critically ill COVID-19 patients frequently present with profound hypoxemia with ARDS requiring mechanical ventilation (MV). 1 According to recently published Covid-19 guidelines, 2 ventilatory support aims at increasing PAO 2 with noninvasive methods and eventually MV. Ventilator settings are optimized to recruit collapsed alveoli and reduce ventilator-induced lung injury. However, in Sars-Cov-2 ARDS, recruitment strategies may be hazardous because of a preserved compliance 3 and a poor response to positive end-expiratory pressure (PEEP), 4 whereas physiological measurements rather show increased intrapulmonary shunt. 5 Abnormal pulmonary vascular dilation and increased perfusion surrounding areas of lung opacity have been identified with dual-energy CT imaging, suggesting that insufficient hypoxic pulmonary vasoconstriction (HPV) may play a major role in the onset of hypoxemia. 6 Almitrine, a drug that used to decrease intrapulmonary shunt by enhancing HPV, improves gas exchange in ARDS. 7 We hypothesized that almitrine could improve hypoxemia in patients with Sars-Cov-2 ARDS. Materials and Methods Study Design This monocenter retrospective study aimed to evaluate the association between almitrine introduction and improvement of oxygenation in Sars-Cov-2 ARDS. The study was conducted in a 36-bed ICU (Hôpital Lariboisière, Paris, France) fully dedicated to the Covid-19 outbreak. The medical records of all patients admitted between March 14, 2020 and April 11, 2020 were reviewed.

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