Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia

Tavazzi, Guido; Pozzi, Marco; Mongodi, Silvia; Dammassa, Valentino; Romito, Giovanni; Mojoli, Francesco

doi:10.1186/s13054-020-03222-9

Cited by 61 publications

(53 citation statements)

References 6 publications

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“…In a recent prospective physiological study [ 31 ] where a two-step positive end-expiratory pressure trial with change of 10 cmH 2 O was applied, potential for lung recruitment was found to vary widely among patients. Similarly, the efficacy of iNO has not been completely defined in COVID-19 patients; although iNO can significantly improve oxygenation, probably helping in redistribution of pulmonary flow [ 14 ], its effect on oxygenation is inconsistent among studies [ 44 ]. Prone positioning has been increasingly used during the pandemic [ 30 , 41 , 45 ], and preliminary reports suggest a beneficial effect of this maneuver on the PaO 2 /F i O 2 ratio.…”

Section: Discussionmentioning

confidence: 99%

Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

et al. 2021

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Background In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. Methods This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. Results Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%, p < 0.001). After PP, a significant increase was observed in PaO2 (from 62 [56–71] to 82 [76–87] mmHg, p = 0.005) and rSO2 (from 53 [52–54]% to 60 [59–64]%, p = 0.005). The use of iNO increased PaO2 (from 65 [67–73] to 72 [67–73] mmHg, p = 0.015) and rSO2 (from 53 [51–56]% to 57 [55–59]%, p = 0.007). The use of ECCO2R decreased PaO2 (from 75 [75–79] to 64 [60–70] mmHg, p = 0.009), with reduction of rSO2 values (59 [56–65]% vs. 56 [53–62]%, p = 0.002). In the whole population, a significant relationship was found between SpO2 and rSO2 (R = 0.62, p < 0.001) and between PaO2 and rSO2 (R0 0.54, p < 0.001). Conclusions Rescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs. Registration The study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).

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Section: Discussionmentioning

confidence: 99%

Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

et al. 2021

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“…Possible benefits of inhaled nitric oxide therapy have been reported in case studies of people with COVID-19, including “home therapy” ( 296 , 306 ), and via portable systems developed for potential use in out-patient settings [reviewed by ( 285 )]. In small clinical studies, inhaled nitric oxide (at doses of 10–25 ppm) did not significantly modify the PaO 2 /FiO 2 ratio (a measure of oxygenation) in ventilated patients with COVID-19, who had refractory hypoxemia ( 307 – 309 ). At a slightly higher dose, inhaled nitric oxide (starting at 30 ppm) improved oxygenation of 21 of 39 non-intubated individuals with COVID-19 ( 310 ).…”

Section: Nitric Oxide and Covid-19mentioning

confidence: 93%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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During the COVID-19 (coronavirus disease of 2019) pandemic, researchers have been seeking low-cost and accessible means of providing protection from its harms, particularly for at-risk individuals such as those with cardiovascular disease, diabetes and obesity. One possible way is via safe sun exposure, and/or dietary supplementation with induced beneficial mediators (e.g., vitamin D). In this narrative review, we provide rationale and updated evidence on the potential benefits and harms of sun exposure and ultraviolet (UV) light that may impact COVID-19. We review recent studies that provide new evidence for any benefits (or otherwise) of UV light, sun exposure, and the induced mediators, vitamin D and nitric oxide, and their potential to modulate morbidity and mortality induced by infection with SARS-CoV-2 (severe acute respiratory disease coronavirus-2). We identified substantial interest in this research area, with many commentaries and reviews already published; however, most of these have focused on vitamin D, with less consideration of UV light (or sun exposure) or other mediators such as nitric oxide. Data collected to-date suggest that ambient levels of both UVA and UVB may be beneficial for reducing severity or mortality due to COVID-19, with some inconsistent findings. Currently unresolved are the nature of the associations between blood 25-hydroxyvitamin D and COVID-19 measures, with more prospective data needed that better consider lifestyle factors, such as physical activity and personal sun exposure levels. Another short-coming has been a lack of measurement of sun exposure, and its potential to influence COVID-19 outcomes. We also discuss possible mechanisms by which sun exposure, UV light and induced mediators could affect COVID-19 morbidity and mortality, by focusing on likely effects on viral pathogenesis, immunity and inflammation, and potential cardiometabolic protective mechanisms. Finally, we explore potential issues including the impacts of exposure to high dose UV radiation on COVID-19 and vaccination, and effective and safe doses for vitamin D supplementation.

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“…Inhaled NO has been suggested as an alternative rescue method before invasive treatment, especially for the relief of hypoxemia. However, according to recent clinical trials in Italy, NO appears unable to reverse oxygenation in patients with extensive mechanical ventilation who had developed persistent hypoxemia [ 104 , 105 ]. Since the targeted effectors of NO in the vascular system and immune system were usually cells or viruses, the inefficacy of NO in the treatment of patients with severe mechanical ventilation might be explained by damage from effectors and excessive viral infection.…”

Section: Limits Of No In the Treatment Of Covid-19mentioning

confidence: 99%

The role of NO in COVID-19 and potential therapeutic strategies

Fang

Jiang

et al. 2021

Free Radical Biology and Medicine

101

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Nitric oxide (NO) is a free radical playing an important pathophysiological role in cardiovascular and immune systems. Recent studies reported that NO levels were significantly lower in patients with COVID-19, which was suggested to be closely related to vascular dysfunction and immune inflammation among them. In this review, we examine the potential role of NO during SARS-CoV-2 infection from the perspective of the unique physical, chemical and biological properties and potential mechanisms of NO in COVID-19, as well as possible therapeutic strategies using inhaled NO. We also discuss the limits of NO treatment, and the future application of this approach in prevention and therapy of COVID-19.

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Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia

Cited by 61 publications

References 6 publications

Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

The role of NO in COVID-19 and potential therapeutic strategies

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