Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study

{ 'DOI': '10.1186/s13054-022-04158-y', 'ISSN': ['1364-8535'], 'URL': 'http://dx.doi.org/10.1186/s13054-022-04158-y', 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>Inhaled nitric oxide (iNO) is used as rescue therapy in patients with ' 'refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) ' 'despite the recommendation against the use of this treatment. To date, the effect of iNO on ' 'the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS ' 'remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill ' 'COVID-19 patients with moderate-to-severe ARDS.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>This multicenter, retrospective cohort study included critically ill ' 'adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. ' 'Eligible patients\xa0with\xa0moderate-to-severe ARDS\xa0were subsequently categorized into ' 'two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary ' 'endpoint was the improvement in oxygenation parameters 24\xa0h after iNO use. Other outcomes ' 'were considered secondary. Propensity score matching (1:2) was used based on the predefined ' 'criteria.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>A total of 1598 patients were screened, and 815 were included based ' 'on the eligibility criteria. Among them, 210 patients were matched based on predefined ' 'criteria. Oxygenation parameters (PaO<jats:sub>2</jats:sub>, FiO<jats:sub>2</jats:sub> ' 'requirement, P/F ratio, oxygenation index) were\xa0significantly improved 24\xa0h after iNO ' 'administration within a median of six\xa0days of ICU admission. However, the risk of\xa0' '30-day and in-hospital mortality were\xa0found to be similar between the two groups (HR: ' '1.18; 95% CI: 0.77, 1.82; <jats:italic>p</jats:italic>\u2009=\u20090.45 and HR: 1.40; 95% CI: ' '0.94, 2.11; <jats:italic>p</jats:italic>=\u20090.10, respectively). On the other hand, ' 'ventilator-free days (VFDs) were significantly fewer, and \xa0ICU and hospital LOS were ' 'significantly longer in the iNO group. In addition, patients who received iNO had higher odds ' 'of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), <jats:italic>p</jats:italic> ' 'value\u2009=\u20090.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, ' '5.83), <jats:italic>p</jats:italic> value\u2009=\u20090.001).</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO ' 'rescue therapy is associated with improved oxygenation parameters but no mortality benefits. ' 'Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and\xa0fewer ' 'VFDs.</jats:p>\n' ' </jats:sec>', 'alternative-id': ['4158'], 'article-number': '304', 'assertion': [ { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Received', 'name': 'received', 'order': 1, 'value': '2 March 2022'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Accepted', 'name': 'accepted', 'order': 2, 'value': '4 September 2022'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'First Online', 'name': 'first_online', 'order': 3, 'value': '3 October 2022'}, {'group': {'label': 'Declarations', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 1}, { 'group': {'label': 'Ethics approval and consent to participate', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 2, 'value': 'The study was approved in December 2020 by King Abdullah International Medical ' 'Research Center Institutional Review Board, Riyadh, Saudi Arabia (Ref.# ' 'RC20.638.R).\xa0Participants’ confidentiality was strictly observed throughout ' 'the study by using anonymous unique serial number for each subject and ' 'restricting data only to the investigators. Informed consent was not required ' "due to the research's method as per the policy of the governmental and local " 'research center.'}, { 'group': {'label': 'Consent for publication', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 3, 'value': 'Not applicable.'}, { 'group': {'label': 'Competing interests', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 4, 'value': 'No author has a conflict of interest in this study.'}], 'author': [ {'affiliation': [], 'family': 'Al Sulaiman', 'given': 'Khalid', 'sequence': 'first'}, {'affiliation': [], 'family': 'Korayem', 'given': 'Ghazwa B.', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Altebainawi', 'given': 'Ali F.', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Al Harbi', 'given': 'Shmeylan', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Alissa', 'given': 'Abdulrahman', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Alharthi', 'given': 'Abdullah', 'sequence': 'additional'}, 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