Comparison of Inhaled Epoprostenol and Inhaled Nitric Oxide for COVID-19 Induced ARDS in Critically Ill Adults

Abstract

Specific Aims: To compare the maximum change of PaO2:FiO2 in 24 hours from baseline for both iEPO and iNO. Secondary aims include exploring the in-hospital mortality and duration of therapy. Methods: Retrospective, cohort study conducted at Banner Health Hospitals. Patients who were administered iNO or iEPO during their ICU admission were evaluated from Jan 2020-Jan 2022. ● Inclusion criteria: (1) ≥ 18 y/o ; (2) continuous administration of iNO or iEPO for ≥ 1 hour in mechanically ventilated patients admitted to the ICU; and (3) COVID-19 induced pneumonia (PaO2 FIO2 < 150 mm Hg) ● Exclusion criteria: (1) >2 hours of concomitant iNO and iEPO administration; (2) indication of use was massive or submassive pulmonary embolism (PE); (3) concomitant parenteral prostacyclin administration; or (4) extracorporeal membrane oxygenation (ECMO) at baseline Results: 188 patients met inclusion criteria for analysis. There was a significant difference in weight between groups (iEPO mean 103.5 vs 94.6 in iNO, p=0.025) and no significant findings when comparing patients with included comorbidities. Vasopressor therapy had no significant difference (Norepinephrine equivalents: p=0.077). More patients were placed in a prone position in the iEPO group (p=0.002) and more patients were paralyzed with neuromuscular blocking agents (NMBA) in the iNO group (p=0.003). The primary aim of comparing the maximum change of PaO2:FiO2 in 24 hours from baseline was not found to be significant (p=0.779). Conclusions: There was no statistically significant difference in the maximum change of PaO2:FiO2 in 24 hours from baseline between the two study groups.