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Rescue therapy with inhaled nitric oxide and almitrine in COVID-19 patients with severe acute respiratory distress syndrome.
Bagate, François; Tuffet, Samuel; Masi, Paul; Perier, François; Razazi, Keyvan; de Prost, Nicolas; Carteaux, Guillaume; Payen, Didier; Mekontso Dessap, Armand.
  • Bagate F; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
  • Tuffet S; Univ Paris Est Créteil, CARMAS, 94010, Créteil, France.
  • Masi P; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
  • Perier F; Univ Paris Est Créteil, CARMAS, 94010, Créteil, France.
  • Razazi K; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
  • de Prost N; Univ Paris Est Créteil, CARMAS, 94010, Créteil, France.
  • Carteaux G; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
  • Payen D; Univ Paris Est Créteil, CARMAS, 94010, Créteil, France.
  • Mekontso Dessap A; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Ann Intensive Care ; 10(1): 151, 2020 Nov 04.
Article in English | MEDLINE | ID: covidwho-992558
Semantic information from SemMedBD (by NLM)
1. almitrine TREATS Severe Acute Respiratory Syndrome
Subject
almitrine
Predicate
TREATS
Object
Severe Acute Respiratory Syndrome
2. almitrine TREATS COVID-19
Subject
almitrine
Predicate
TREATS
Object
COVID-19
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. Severe Acute Respiratory Syndrome PROCESS_OF Patients
Subject
Severe Acute Respiratory Syndrome
Predicate
PROCESS_OF
Object
Patients
5. almitrine TREATS Patients
Subject
almitrine
Predicate
TREATS
Object
Patients
6. nitric oxide TREATS Patients
Subject
nitric oxide
Predicate
TREATS
Object
Patients
7. Blood Vessel LOCATION_OF Pulmonary Dysfunction
Subject
Blood Vessel
Predicate
LOCATION_OF
Object
Pulmonary Dysfunction
8. almitrine TREATS Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
Subject
almitrine
Predicate
TREATS
Object
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
9. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
10. nitric oxide ADMINISTERED_TO Patients
Subject
nitric oxide
Predicate
ADMINISTERED_TO
Object
Patients
11. nitric oxide COEXISTS_WITH almitrine
Subject
nitric oxide
Predicate
COEXISTS_WITH
Object
almitrine
12. Pulmonary function AFFECTS COVID-19
Subject
Pulmonary function
Predicate
AFFECTS
Object
COVID-19
13. almitrine TREATS Severe Acute Respiratory Syndrome
Subject
almitrine
Predicate
TREATS
Object
Severe Acute Respiratory Syndrome
14. almitrine TREATS COVID-19
Subject
almitrine
Predicate
TREATS
Object
COVID-19
15. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
16. Severe Acute Respiratory Syndrome PROCESS_OF Patients
Subject
Severe Acute Respiratory Syndrome
Predicate
PROCESS_OF
Object
Patients
17. almitrine TREATS Patients
Subject
almitrine
Predicate
TREATS
Object
Patients
18. nitric oxide TREATS Patients
Subject
nitric oxide
Predicate
TREATS
Object
Patients
19. Blood Vessel LOCATION_OF Pulmonary Dysfunction
Subject
Blood Vessel
Predicate
LOCATION_OF
Object
Pulmonary Dysfunction
20. almitrine TREATS Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
Subject
almitrine
Predicate
TREATS
Object
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
21. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
22. nitric oxide ADMINISTERED_TO Patients
Subject
nitric oxide
Predicate
ADMINISTERED_TO
Object
Patients
23. nitric oxide COEXISTS_WITH almitrine
Subject
nitric oxide
Predicate
COEXISTS_WITH
Object
almitrine
24. Pulmonary function AFFECTS COVID-19
Subject
Pulmonary function
Predicate
AFFECTS
Object
COVID-19
ABSTRACT

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 (PaO2/FiO2 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 PaO2/FiO2 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.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Ann Intensive Care Year: 2020 Document Type: Article Affiliation country: S13613-020-00769-2

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Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Ann Intensive Care Year: 2020 Document Type: Article Affiliation country: S13613-020-00769-2