Initiation of Inhaled Nitric Oxide by an Air Transport Team in Adult Coronavirus Disease 2019 Respiratory Failure

Brown, Connor J.; Lai, Jason; Rubel, Nicholas; Ward, Christen; McLean, Justin; Wheelock, Martin; Steuerwald, Michael; Cathers, Andrew

doi:10.1016/j.amj.2022.03.001

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…After excluding duplicate articles and screening titles and abstracts, 84 articles were evaluated for full-text review. Among these, we found 35 relevant articles (2 RCTs, 19 cohort studies, 1 case-control study, 1 cross-sectional study, and 12 case reports) ( Figure 1 ) ( Abou-Arab et al, 2020 ; Bagate et al, 2020 ; Barthélémy et al, 2020 ; Cardinale et al, 2020 ; Ferrari et al, 2020 ; Huette et al, 2020 ; Losser et al, 2020 ; Safaee Fakhr et al, 2020 ; Tavazzi et al, 2020 ; Caplan et al, 2021 ; Chandel et al, 2021 ; Feng et al, 2021 ; Garfield et al, 2021 ; Giri et al, 2021 ; Herranz et al, 2021 ; Heuts et al, 2021 ; Huette et al, 2021 ; Laghlam et al, 2021 ; Longobardo et al, 2021 ; Lotz et al, 2021 ; Moni et al, 2021 ; Paramanathan et al, 2021 ; Ziehr et al, 2021 ; Al Sulaiman et al, 2022 ; Brown et al, 2022 ; Kalfon et al, 2022 ; Lubinsky et al, 2022 ; Poonam et al, 2022 ; Vives et al, 2022 ; Bicakcioglu et al, 2023 ; Blot et al, 2023 ; Di Fenza et al, 2023 ; Mekontso Dessap et al, 2023 ; Saccheri et al, 2023 ; van Zyl et al, 2023 ).…”

Section: Resultsmentioning

confidence: 99%

Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review

Wang,

Yu,

Tian

et al. 2024

Front. Pharmacol.

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Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, a large number of critically ill and severe COVID-19 patients meet the diagnostic criteria for sepsis and even septic shock. The treatments for COVID-19 patients with sepsis are still very limited. For sepsis, improving ventilation is one of the main treatments. Nitric oxide (NO) and almitrine have been reported to improve oxygenation in patients with “classical” sepsis. Here, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of NO, almitrine, and the combination of both for COVID-19 (at the edge of sepsis) patients.Method: A systematic search was performed on Embase, PubMed, the Cochrane Library, the Web of Science, Wanfang Data, and China National Knowledge Infrastructure. Randomized clinical trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports in COVID-19 patients with suspected or confirmed sepsis were performed. Study characteristics, patient demographics, interventions, and outcomes were extracted from eligible articles.Results: A total of 35 studies representing 1,701 patients met eligibility criteria. Inhaled NO did not affect the mortality (OR 0.96, 95% CI 0.33–2.8, I2 = 81%, very low certainty), hospital length of stay (SMD 0.62, 95% CI 0.04–1.17, I2 = 83%, very low certainty), and intubation needs (OR 0.82, 95% CI 0.34–1.93, I2 = 56%, very low certainty) of patients with COVID-19 (at the edge of sepsis). Meanwhile, almitrine did not affect the mortality (OR 0.44, 95% CI 0.17–1.13, low certainty), hospital length of stay (SMD 0.00, 95% CI -0.29–0.29, low certainty), intubation needs (OR 0.94, 95% CI 0.5–1.79, low certainty), and SAEs (OR 1.16, 95% CI 0.63–2.15, low certainty). Compared with pre-administration, the PaO2/FiO2 of patients with NO (SMD-0.87, 95% CI -1.08–0.66, I2 = 0%, very low certainty), almitrine (SMD-0.73, 95% CI-1.06–0.4, I2 = 1%, very low certainty), and the combination of both (SMD-0.94, 95% CI-1.71–0.16, I2 = 47%, very low certainty) increased significantly.Conclusion: Inhaled NO, almitrine, and the combination of the two drugs improved oxygenation significantly, but did not affect the patients’ mortality, hospitalization duration, and intubation needs. Almitrine did not significantly increase the patients’ SAEs. Well-designed high-quality studies are needed for establishing a stronger quality of evidence.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367667, identifier CRD42022367667.

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Section: Resultsmentioning

confidence: 99%

Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review

Wang,

Yu,

Tian

et al. 2024

Front. Pharmacol.

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“…Severe hypoxemia can occur in critically ill patients during air transport on helicopters with cabin altitudes exceeding 4,000 feet (equivalent to 1219.2 meters) or on fixed-wing aircraft with cabin altitudes exceeding 6,000 feet (equivalent to 1828.8 meters) (1). Severe hypoxemia in the lung resulting from hypobaric and hypoxic conditions during aeromedical evacuation is one of the few factors restricting patient transport (2). Acute lung injury (ALI) is a critical condition characterized by diffuse inflammatory alveolar infiltration, bleeding, pulmonary edema, and the formation of hyaline membranes in response to pathological factors inside and outside the lung.…”

Section: Introductionmentioning

confidence: 99%

SIMULATED AEROMEDICAL EVACUATION EXACERBATES ACUTE LUNG INJURY VIA HYPOXIA-INDUCIBLE FACTOR-1α-MEDIATED BNIP3/NIX-DEPENDENT MITOPHAGY

Yin,

Liu,

et al. 2024

Shock

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Background With the advancement of medicine and the development of technology, the limiting factors of aeromedical evacuation are gradually decreasing, and the scope of indications is expanding. However, the hypobaric and hypoxic environments experienced by critically ill patients in flight can cause lung injury, leading to inflammation and hypoxemia, which remains one of the few limiting factors for air medical evacuation. This study aimed to examine the mechanism of secondary lung injury in rat models of acute lung injury that simulate aeromedical evacuation. Methods An acute lung injury model was induced in SD rats by the administration of lipopolysaccharide (LPS) followed by exposure to a simulated aeromedical evacuation environment (equivalent to 8,000 feet above sea level) or a normobaric normoxic environment for 4 hours. The expression of hypoxia-inducible transcription-1 α (HIF-1α) was stabilized by pretreatment with dimethyloxalylglycine (DMOG). The reactive oxygen species (ROS) levels and the protein expression levels of HIF-1α, BNIP3 and NIX in lung tissue were measured. Results Simulated aeromedical evacuation exacerbated pathological damage to lung tissue and increased the release of inflammatory cytokines in serum as well as the ROS levels and the protein levels of HIF-1α, BNIP3, and NIX in lung tissue. Pretreatment with DMOG resulted in increases in the protein expression of HIF-1α, BNIP3 and NIX. Conclusion Simulated aeromedical evacuation leads to secondary lung injury through mitophagy.

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Acute Respiratory Distress Syndrome: Updates for Critical Care Transport

Roginski,

Atchinson,

Esteves

et al. 2024

Air Medical Journal

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Initiation of Inhaled Nitric Oxide by an Air Transport Team in Adult Coronavirus Disease 2019 Respiratory Failure

Cited by 5 publications

References 23 publications

Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review

Unraveling the impact of nitric oxide, almitrine, and their combination in COVID-19 (at the edge of sepsis) patients: a systematic review

SIMULATED AEROMEDICAL EVACUATION EXACERBATES ACUTE LUNG INJURY VIA HYPOXIA-INDUCIBLE FACTOR-1α-MEDIATED BNIP3/NIX-DEPENDENT MITOPHAGY

Acute Respiratory Distress Syndrome: Updates for Critical Care Transport

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