• Anthony Steven Lubinsky, Shari B Brosnahan, Andrew Lehr, Ola Elnadoury, Jacklyn Hagedorn, Bhaskara Garimella, Michael T Bender, Nancy Amoroso, Antonio Artigas, BosLieuwe D JLDJIntensive Care, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., and David Kaufman.
• New York University Langone Health, 550 1(st) Ave, New York, NY 10016, United States of America. Electronic address: anthony.lubinsky@nyulangone.org.
• J Crit Care. 2022 Jun 1; 69: 153990153990.

PurposeMeasure the effect of inhaled pulmonary vasodilators on gas exchange in mechanically ventilated patients with COVID-19.MethodsA retrospective observational cohort study at three New York University Hospitals was performed including eighty-four mechanically ventilated SARS Cov-2 nasopharyngeal PCR positive patients, sixty nine treated with inhaled nitric oxide (iNO) and fifteen with inhaled epoprostenol (iEPO). The primary outcomes were change in PAO2:FIO2 ratio, oxygenation Index (OI), and ventilatory ratio (VR) after initiation of inhaled pulmonary vasodilators.ResultsThere was no significant change in PAO2:FIO2ratio after initiation of iNO (mean - 4.1, 95% CI -17.3-9.0, P = 0.54) or iEPO (mean - 3.4, 95% CI -19.7-12.9, P = 0.66), in OI after initiation of iNO (mean 2.1, 95% CI-0.04-4.2, P = 0.054) or iEPO (mean - 3.4, 95% CI -19.7-12.9, P = 0.75), or in VR after initiation of iNO (mean 0.17, 95% CI -0.03-0.36, P = 0.25) or iEPO (mean 0.33, 95% CI -0.0847-0.74, P = 0.11). PAO2:FIO2, OI and VR did not significantly change over a five day period starting the day prior to drug initiation in patients who received either iNO or iEPO assessed with a fixed effects model.ConclusionInhaled pulmonary vasodilators were not associated with significant improvement in gas exchange in mechanically ventilated patients with COVID-19.Copyright © 2022. Published by Elsevier Inc.

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