Abstract
IntroductionInhaled epoprostenol (iEpo) is a pulmonary vasodilator used to treat refractory respiratory failure, including that caused by Coronavirus 2019 (COVID-19) pneumonia.Aim of StudyTo describe the experience at three teaching hospitals using iEpo for severe respiratory failure due to COVID-19 and evaluate its efficacy in improving oxygenation.MethodsFifteen patients were included who received iEpo, had confirmed COVID-19 and had an arterial blood gas measurement in the 12 hours before and 24 hours after iEpo initiation.ResultsEleven patients received prone ventilation before iEpo (73.3%), and six (40%) were paralyzed. The partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) improved from 95.7 mmHg to 118.9 mmHg (p=0.279) following iEpo initiation. In the nine patients with severe ARDS, the mean P/F ratio improved from 66.1 mmHg to 95.7 mmHg (p=0.317). Ultimately, four patients (26.7%) were extubated after an average of 9.9 days post-initiation.ConclusionsThe findings demonstrated a trend towards improvement in oxygenation in critically ill COVID-19 patients. Although limited by the small sample size, the results of this case series portend further investigation into the role of iEpo for severe respiratory failure associated with COVID-19.
Highlights
IntroductionCoronavirus disease 2019 (COVID-19) has emerged as a global pandemic, from the first case described in Wuhan, China, in December 2019, to almost 7 million cases and over 400,000 deaths worldwide as of June 2020.1 Recent data suggest the rate of critical illness lies between 5-22%, with corresponding mortality up to 61% in the critically ill [1,2,3,4]
Inhaled epoprostenol is a pulmonary vasodilator used to treat refractory respiratory failure, including that caused by Coronavirus 2019 (COVID-19) pneumonia
Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, from the first case described in Wuhan, China, in December 2019, to almost 7 million cases and over 400,000 deaths worldwide as of June 2020.1 Recent data suggest the rate of critical illness lies between 5-22%, with corresponding mortality up to 61% in the critically ill [1,2,3,4]
Summary
Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, from the first case described in Wuhan, China, in December 2019, to almost 7 million cases and over 400,000 deaths worldwide as of June 2020.1 Recent data suggest the rate of critical illness lies between 5-22%, with corresponding mortality up to 61% in the critically ill [1,2,3,4]. For cases of refractory hypoxemic respiratory failure in ARDS, salvage therapies include prone positioning, neuromuscular blockade (NMB), inhaled pulmonary vasodilators and extracorporeal membrane oxygenation (ECMO) [7]. The rapid development of respiratory failure in COVID-19, without any definitive antiviral therapies, and limited access to ECMO centres, has forced many clinicians into using inhaled pulmonary vasodilators as therapies of last resort. The pulmonary vasodilators, nitric oxide (iNO) and epoprostenol (iEpo) have been shown to improve oxygenation in ARDS with no effect on mortality, ventilator-free days, or attenuation in disease severity [13,14]. No published studies describing the use of inhaled pulmonary vasodilators in treating ARDS in COVID-19 patients were found in the literature current at the time of writing. The cases series aims to describe the experience of treating a cohort of critically ill COVID-19 patients with inhaled epoprostenol in three institutions
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