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British Journal of Anaesthesia
BJA

Potential for personalised application of inhaled nitric oxide in COVID-19 pneumonia

Published:November 14, 2020DOI:https://doi.org/10.1016/j.bja.2020.11.006
      Editor—Coronavirus disease 2019 (COVID-19) has affected 31.1 million people worldwide and caused more than 1.2 million deaths as of November 2020.

      World Health Organisation. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019; Accessed 25 Oct 2020.

      The majority of critical care patients with COVID-19 pneumonia fulfil the Berlin definition of acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation.
      • Phua J.
      • Weng L.
      • Ling L.
      • et al.
      Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations.
      Despite standard ARDS interventions with high positive end-expiratory pressure, prone positioning and lung protective ventilation, some patients remain profoundly hypoxaemic and hypercapnic.
      • Phua J.
      • Weng L.
      • Ling L.
      • et al.
      Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations.
      Inhaled nitric oxide (iNO) has been a rescue strategy used previously in ARDS, where it increases the PaO2/FiO2 ratio and reduces physiologic dead space fraction at 24 h, but without improving mortality or ICU length of stay.
      • Gebistorf F.
      • Karam O.
      • Wetterslev J.
      • et al.
      Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults.
      A dual role for iNO has been proposed in COVID-19 as an anti-viral agent and as a pulmonary vasodilator, especially given the ‘pulmonary vascular’ phenotype increasingly apparent in this disease.
      • Hedenstierna G.
      • Chen L.
      • Hedenstierna M.
      • et al.
      Treatment of COVID-19 by inhaled NO to reduce shunt?.
      ,
      • Patel B.V.
      • Arachchillage D.J.
      • Ridge C.A.
      • et al.
      Pulmonary angiopathy in severe COVID-19: physiologic, imaging and hematologic observations.

      Keywords

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