Respiratory failure & ventilation
Impact of low dose inhaled nitric oxide treatment in spontaneously breathing and intubated COVID-19 patients: a retrospective propensity-matched study
Authors' conclusion
This retrospective propensity-score matched study showed that spontaneously breathing COVID-19 patients on HFNC/ NIV support had a decreased in-hospital mortality risk with iNO use in a time-to-event analysis. Both intubated and spontaneously breathing patients had improvement in oxygenation parameters with iNO therapy but were associated with longer in-hospital stays, ICU stays, ventilation duration, and higher incidence of creatinine rise.
Study context
- Population
- COVID-19 patients in the SCCM VIRUS COVID-19 registry at Mayo Clinic sites, March 2020–June 2022, requiring high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or invasive mechanical ventilation1,879 spontaneously breathing, 888 intubated
- Participants
- 2,767 patients
- Exposure
- Inhaled nitric oxide (iNO) vs no iNO, in spontaneously breathing and intubated patients
- Spontaneously breathing, iNOn = 153
- Intubated, iNOn = 193
- Outcome
- In-hospital mortality (time-to-event, Cox model)
Methodological detailsmulticentre, propensity-score matched, inverse propensity of treatment weighting
- Multicentre
- Propensity-score matched
- Inverse propensity of treatment weighting
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | OR (CI) | |
|---|---|---|
| Intubation risk (spontaneously breathing)Spontaneously breathing, iNO vs Spontaneously breathing, no iNO · PSM | 1.08 (0.71–1.65) | |
| Intubation risk (spontaneously breathing)Spontaneously breathing, iNO vs Spontaneously breathing, no iNO · IPTW | 1.10 (0.90–1.33) | |
| 0.512Odds ratio (log scale) |
Intubation risk (spontaneously breathing)
- No significant difference in intubation risk with iNO
FiO2 requirement, P/F ratio, respiratory rate · within 48 h of iNO use
- Consistent improvement with iNO in both spontaneously breathing and intubated groups
Hospital stay, ICU stay, ventilation duration
- iNO associated with longer hospital and ICU stays and ventilation duration
Safety
Creatinine rise
- Higher incidence with iNO
Original publication
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