Photo Credit: Jesus Rodriguez

The following is a summary of “Impact of low dose inhaled nitric oxide treatment in spontaneously breathing and intubated COVID-19 patients: a retrospective propensity-matched study,” published in the October 2024 issue of Critical Care by Isha et al.  

The effectiveness of inhaled nitric oxide (iNO) therapy for COVID-19-related ARDS is still unclear.   

Researchers conducted a retrospective study assessing how iNO affects patients with COVID-19 needing respiratory support, using data from a multicenter retrospective study.   

They analyzed patients with COVID-19 from the SCCM VIRUS COVID-19 registry who were admitted to Mayo Clinic sites (March 2020 – June 2022) and needed high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation (IMV). Based on their iNO usage, patients were grouped as “spontaneously breathing” or “intubated.” Outcomes were examined using propensity score matching (PSM) and inverse propensity of treatment weighting (IPTW) analysis.  

The results showed that among 2,767 patients, 1,879 were spontaneously breathing (153 received iNO), and 888 were intubated (193 received iNO). In both groups, FiO2, P/F ratio, and respiratory rate improved within 48 hours of iNO use. However, iNO did not lower intubation risk in patients breathing spontaneously (PSM OR 1.08, CI: 0.71-1.65; IPTW OR 1.10, CI: 0.90 – 1.33). It also showed that iNO reduced in-hospital mortality risk for spontaneously breathing patients (PSM HR 0.49, CI: 0.31-0.75; IPTW HR 0.40, CI: 0.26-0.62), but not for patients who were intubated. The use of iNO was also linked to longer hospital and ICU stays, extended ventilation, and higher creatinine levels.   

 Investigators concluded that iNO therapy lowered the in-hospital mortality risk for patients with spontaneous breathing suffering from COVID-19 on HFNC/NIV and improved oxygenation in both breathing groups. However, it was linked to longer hospital stays, ICU stays, ventilation, and increased creatinine levels.  

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05093-w