Abstract
TYPE: Abstract TOPIC: Chest Infections PURPOSE: There are no proven pharmacologic interventions for COVID-19 that primarily target the respiratory system. This study evaluated the safety and the beneficial effects of high-dose inhaled nitric oxide (NO) in non-intubated patients with COVID-19. METHODS: In this interventional study, NO gas (160 parts-per-million [ppm]) was administered for thirty minutes twice daily in hospitalized, non-intubated COVID-19 patients. RESULTS: Between March and June 2020, twenty-nine COVID-19 patients received a total of 217 inhaled NO treatments. The maximum level of nitrogen dioxide was 1.5 ppm. The peak level of methemoglobin (MetHb) during the treatments was 4.7% and decreased in all patients 5 minutes after NO discontinuation. No adverse events, such as hypoxemia or hypotension, occurred during treatments, and none of the patients experienced acute kidney injury during hospitalization. Breathing NO acutely decreased the respiratory rate of tachypneic patients and improved oxygenation in hypoxemic patients [Figure 1]. One of the 29 patients studied required invasive mechanical ventilation and none of the patients died during the trial. The median hospital length of stay was 6 days [interquartile range 4-8]. Discharged patients did not require hospital readmission and did not develop sequelae of COVID-19 during 28 days of follow-up. CONCLUSIONS: In non-intubated COVID-19 patients, administration of inhaled NO at 160 ppm for 30 minutes twice daily decreased the respiratory rate of tachypneic patients and improved oxygenation in hypoxemic patients without any adverse events. CLINICAL IMPLICATIONS: High-dose NO gas might be a valuable treatment option in non-intubated patients with COVID-19 infection. DISCLOSURE: The study medication was provided free of charge by Praxair Inc and by Airgas Healthcare, an Air Liquide company. The non-invasive co-oximeter was provided by Masimo Corp (the companies did not oversight the study). KEYWORD: Nitric Oxide
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