Letter to the Editor: “Use of inhaled epoprostenol with high flow nasal oxygen in non-intubated patients with severe COVID-19”

Chiles, J.W.; Vijaykumar, Kadambari; Darby, Adrienne; Goetz, R.L.; Kane, Lauren; Methukupally, Abhishek R; Gandotra, Sheetal; Russell, Derek W.; Whitson, Matthew J.; Kelmenson, Daniel A

doi:10.1016/j.jcrc.2022.153989

Cited by 4 publications

(8 citation statements)

References 11 publications

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“…After the removal of duplicate references, 4,517 references were available for screening. Ultimately, we identified 23 studies (10, 19–40) that met our inclusion criteria ( Fig. 1 ; and Table S3 , http://links.lww.com/CCX/B205).…”

Section: Resultsmentioning

confidence: 99%

Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Torbic

Saini

Harnegie

et al. 2023

Critical Care Explorations

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OBJECTIVES:Studies evaluating inhaled prostacyclins for the management of acute respiratory distress syndrome (ARDS) have produced inconsistent results regarding their effect on oxygenation. The purpose of this systematic review and meta-analysis was to evaluate the change in the Pao 2 /Fio 2 ratio after administration of an inhaled prostacyclin in patients with ARDS. DATA SOURCES:We searched Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, and Web of Science. STUDY SELECTION:We included abstracts and trials evaluating administration of inhaled prostacyclins in patients with ARDS.DATA EXTRACTION: Change in the Pao 2 /Fio 2 ratio, Pao 2 , and mean pulmonary artery pressure (mPAP) were extracted from included studies. Evidence certainty and risk of bias were evaluated using Grading of Recommendations Assessment, Development, and Evaluation and the Cochrane Risk of Bias tool. DATA SYNTHESIS:We included 23 studies (1,658 patients) from 6,339 abstracts identified by our search strategy. The use of inhaled prostacyclins improved oxygenation by increasing the Pao 2 /Fio 2 ratio from baseline (mean difference [MD], 40.35; 95% CI, 26.14-54.56; p < 0.00001; I 2 = 95%; very low quality evidence). Of the eight studies to evaluate change in Pao 2 , inhaled prostacyclins also increased Pao 2 from baseline (MD, 12.68; 95% CI, 2.89-22.48 mm Hg; p = 0.01; I 2 = 96%; very low quality evidence). Only three studies evaluated change in mPAP, but inhaled prostacyclins were found to improve mPAP from baseline (MD, -3.67; 95% CI, -5.04 to -2.31 mm Hg; p < 0.00001; I 2 = 68%; very low quality evidence). CONCLUSIONS:In patients with ARDS, use of inhaled prostacyclins improves oxygenation and reduces pulmonary artery pressures. Overall data are limited and there was high risk of bias and heterogeneity among included studies. Future studies evaluating inhaled prostacyclins for ARDS should evaluate their role in ARDS subphenotypes, including cardiopulmonary ARDS.

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Section: Resultsmentioning

confidence: 99%

Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Torbic

Saini

Harnegie

et al. 2023

Critical Care Explorations

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“…Eventually, 18 studies were included in the 1-arm meta-analysis (13 single arm retrospective studies 18 – 30 and 5 case series 31 – 35 ) and three studies 13 , 14 , 36 in the 2-arm meta-analysis. Figure 1 shows the PRISMA flow chart that illustrates how the final studies were selected.…”

Section: Resultsmentioning

confidence: 99%

“…Table 5 summarizes the outcomes of the responder versus non-responder subgroup analysis. Seven studies 13 , 18 , 20 – 23 , 27 specifically looked at IPVD responders and non-responders. Baseline P/F ratios were significantly lower in the IPVD responder group compared to non-responders (MD −24.57 mm Hg; 95% CI −38.11-11.02; P = .0004, I 2 = 39%, Figure 5A ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 782 studies underwent full-length review. Subsequently, we excluded 761 studies because of the following: 317 studies used interventions not involved in our study Eventually, 18 studies were included in the 1-arm metaanalysis (13 single arm retrospective studies [18][19][20][21][22][23][24][25][26][27][28][29][30] and 5 case series [31][32][33][34][35] ) and three studies 13,14,36 in the 2-arm meta-analysis. Figure 1 shows the PRISMA flow chart that illustrates how the final studies were selected.…”

Section: Study Selectionmentioning

confidence: 99%

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Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis

Khokher

Malhas

Beran

et al. 2022

J Intensive Care Med

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Introduction: Inhaled pulmonary vasodilators (IPVD) have been previously studied in patients with non-coronavirus disease-19 (COVID-19) related acute respiratory distress syndrome (ARDS). The use of IPVD has been shown to improve the partial pressure of oxygen in arterial blood (PaO2), reduce fraction of inspired oxygen (FiO2) requirements, and ultimately increase PaO2/FiO2 (P/F) ratios in ARDS patients. However, the role of IPVD in COVID-19 ARDS is still unclear. Therefore, we performed this meta-analysis to evaluate the role of IPVD in COVID-19 patients. Methods: Comprehensive literature search of PubMed, Embase, Web of Science and Cochrane Library databases from inception through April 22, 2022 was performed for all published studies that utilized IPVD in COVID-19 ARDS patients. The single arm studies and case series were combined for a 1-arm meta-analysis, and the 2-arm studies were combined for a 2-arm meta-analysis. Primary outcomes for the 1-arm and 2-arm meta-analyzes were change in pre- and post-IPVD P/F ratios and mortality, respectively. Secondary outcomes for the 1-arm meta-analysis were change in pre- and post-IPVD positive end-expiratory pressure (PEEP) and lung compliance, and for the 2-arm meta-analysis the secondary outcomes were need for endotracheal intubation and hospital length of stay (LOS). Results: 13 single arm retrospective studies and 5 case series involving 613 patients were included in the 1-arm meta-analysis. 3 studies involving 640 patients were included in the 2-arm meta-analysis. The pre-IPVD P/F ratios were significantly lower compared to post-IPVD, but there was no significant difference between pre- and post-IPVD PEEP and lung compliance. The mortality rates, need for endotracheal intubation, and hospital LOS were similar between the IPVD and standard therapy groups. Conclusion: Although IPVD may improve oxygenation, our investigation showed no benefits in terms of mortality compared to standard therapy alone. However, randomized controlled trials are warranted to validate our findings.

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“…The role of pulmonary vasodilators as a rescue therapy has been established in the non-COVID-19 ARDS population, with improvement in physiologic parameters but no mortality benefit 84 . The current evidence regarding the use of inhaled pulmonary vasodilators as a rescue therapy in refractory hypoxic respiratory failure secondary to COVID-19 ARDS is limited 85 , 86 , 87 , 88 and does not allow for definitive conclusions. Current guidelines recommend against the routine use of inhaled nitric oxide and for the use of a trial of inhaled pulmonary vasodilators as a rescue therapy 50 , 82 .…”

Section: Discussionmentioning

confidence: 99%

Lessons Learned in Mechanical Ventilation/Oxygen Support in Coronavirus Disease 2019

Dragoi

Siuba

Fan

2023

Clinics in Chest Medicine

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Letter to the Editor: “Use of inhaled epoprostenol with high flow nasal oxygen in non-intubated patients with severe COVID-19”

Cited by 4 publications

References 11 publications

Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis

Lessons Learned in Mechanical Ventilation/Oxygen Support in Coronavirus Disease 2019

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