Background In COVID-19 patients with severe acute respiratory distress syndrome (ARDS), the relatively preserved respiratory system compliance despite severe hypoxemia, with specific pulmonary vascular dysfunction, suggests a possible hemodynamic mechanism for VA/Q mismatch, as hypoxic vasoconstriction alteration. This study aimed to evaluate the capacity of inhaled nitric oxide (iNO)–almitrine combination to restore oxygenation in severe COVID-19 ARDS (C-ARDS) patients. Methods We conducted a monocentric preliminary pilot study in intubated patients with severe C-ARDS. Respiratory mechanics was assessed after a prone session. Then, patients received iNO (10 ppm) alone and in association with almitrine (10 μg/kg/min) during 30 min in each step. Echocardiographic and blood gases measurements were performed at baseline, during iNO alone, and iNO–almitrine combination. The primary endpoint was the variation of oxygenation (PaO 2 /FiO 2 ratio). Results Ten severe C-ARDS patients were assessed (7 males and 3 females), with a median age of 60 [52–72] years. Combination of iNO and almitrine outperformed iNO alone for oxygenation improvement. The median of PaO 2 /FiO 2 ratio varied from 102 [89–134] mmHg at baseline, to 124 [108–146] mmHg after iNO ( p = 0.13) and 180 [132–206] mmHg after iNO and almitrine ( p < 0.01). We found no correlation between the increase in oxygenation caused by iNO–almitrine combination and that caused by proning. Conclusion In this pilot study of severe C-ARDS patients, iNO–almitrine combination was associated with rapid and significant improvement of oxygenation. These findings highlight the role of pulmonary vascular function in COVID-19 pathophysiology.
【저자키워드】 COVID-19, ARDS, iNO, Almitrine, 【초록키워드】 severe COVID-19, nitric oxide, Variation, pathophysiology, male, Patient, Compliance, Inhaled, Respiratory system, vascular dysfunction, respiratory, patients, mechanism, Blood, association, acute respiratory distress, hemodynamic, Combination, primary endpoint, COVID-19 patient, Oxygenation, pilot study, median age, syndrome, severe hypoxemia, no correlation, vasoconstriction, proning, Vascular function, females, highlight, hypoxic, Result, performed, evaluate, caused, conducted, median, increase in, baseline, intubated patient, PaO, preserved, were assessed, 【제목키워드】 therapy, nitric oxide, Inhaled, acute respiratory distress, COVID-19 patient, rescue, syndrome,