UTILIZING COMBINATION THERAPY WITH INHALED EPOPROSTENOL AND LOOP DIURETICS IN ACUTE HYPOXIC RESPIRATORY FAILURE FROM COVID-19

ABSTRACT

SESSION TITLE What Lessons Will We Take From the Pandemic? SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/19/2022 1115 am - 1215 pm PURPOSE: Inhaled pulmonary vasodilators such as epoprostenol (IE) and nitric oxide have been used to treat refractory hypoxemia due to COVID-19 by improving ventilation-perfusion mismatch. One undesirable consequence of this therapy is increased left atrial pressures and risk of pulmonary edema due to systemic vasodilation. The concomitant use of diuretics could mitigate this side effect thereby optimizing IE’s therapeutic impact. The aim of this study was to assess improvement in oxygenation in spontaneously breathing and mechanically ventilated patients with COVID-19 who received IE alone and those who received both IE and loop diuretic (LD) within 24 hours of each other. METHODS: This is a retrospective case control study approved by the local IRB. Improvement in oxygenation was defined as an improvement in the PaO2/FiO2 (PF) ratio by at least 10% within the 24 hours following therapy. SpO2/FiO2 (SF) ratio was used as a surrogate in cases where arterial blood gas trend was not available. Data was analyzed using SPSS version 26 and chi-square analysis was used to compare the 2 groups. RESULTS: A total of 80 patients with COVID-19, confirmed through RT-PCR, received IE from October 2020 to February 2022. Patients were stratified into 2 groups combination therapy with IE and LD (IE-LD;n = 34;42.5%) vs IE alone (n = 46;57.5%). Improvement in oxygenation was seen in 82.4% IE-LD patients, which was a statistically significant difference compared to19.6% IE patients (z = 5.568, p <.00001). Hospital length-of-stay was comparable (19.6 days in IE-LD, 25.0 days in IE;p = 0.13) but there was a trend towards decreased in-hospital mortality (64.7% in IE-LD, 82.6% in IE only). The eventual need for mechanical ventilation in spontaneously breathing patients (52.9% in IE-LD, 56.3% in IE;p = 0.85) and mean ventilator days in intubated patients (14.3 days in IE-LD, 16.6 days in IE;p = 0.61) were not statistically different between the 2 groups. CONCLUSIONS: IE is a valuable rescue therapy in cases of refractory hypoxemia due to Covid-19 as previous studies have shown that approximately half of all patients will show improvement in oxygenation. In our study, 43 out of 80 patients had an increase in PF or SF ratio of at least 10% and the majority of these received combination therapy rather than IE alone, suggesting that LD is an effective adjunct to IE. CLINICAL IMPLICATIONS The role of inhaled pulmonary vasodilators in management of Covid-19 is well-documented as they have been shown to delay intubation in spontaneously breathing Covid-19 patients. Despite the small sample size and retrospective design, our study reports that using LD to minimize inadvertent effects of pulmonary edema when administering IE, can further improve oxygenation in this population. Thus, more studies investigating this combination therapy are warranted. DISCLOSURES No relevant relationships by Kristine Bessette No relevant relationships by Raj Parikh No relevant relationships by Michael Perkins No relevant relationships by Mari-Elena Pino No relevant relationships by Saimir Sharofi