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Impact of low dose inhaled nitric oxide treatment in spontaneously breathing and intubated COVID-19 patients: a retrospective propensity-matched study
Critical Care ( IF 8.8 ) Pub Date : 2024-10-25 , DOI: 10.1186/s13054-024-05093-w Shahin Isha, Prasanth Balasubramanian, Abby J. Hanson, Sadhana Jonna, Lekhya Raavi, Subekshya Khadka, Ananya Vasudhar, Jorge Sinclair De Frias, Anna Jenkins, Arvind Balavenkataraman, Aysun Tekin, Vikas Bansal, Swetha Reddy, Sean M. Caples, Syed Anjum Khan, Nitesh K. Jain, Abigail T. LaNou, Rahul Kashyap, Rodrigo Cartin-Ceba, Ricardo Diaz Milian, Carla P. Venegas, Anna B. Shapiro, Anirban Bhattacharyya, Sanjay Chaudhary, Sean P. Kiley, Quintin J. Quinones, Neal M. Patel, Pramod K. Guru, Pablo Moreno Franco, Devang K. Sanghavi
Critical Care ( IF 8.8 ) Pub Date : 2024-10-25 , DOI: 10.1186/s13054-024-05093-w Shahin Isha, Prasanth Balasubramanian, Abby J. Hanson, Sadhana Jonna, Lekhya Raavi, Subekshya Khadka, Ananya Vasudhar, Jorge Sinclair De Frias, Anna Jenkins, Arvind Balavenkataraman, Aysun Tekin, Vikas Bansal, Swetha Reddy, Sean M. Caples, Syed Anjum Khan, Nitesh K. Jain, Abigail T. LaNou, Rahul Kashyap, Rodrigo Cartin-Ceba, Ricardo Diaz Milian, Carla P. Venegas, Anna B. Shapiro, Anirban Bhattacharyya, Sanjay Chaudhary, Sean P. Kiley, Quintin J. Quinones, Neal M. Patel, Pramod K. Guru, Pablo Moreno Franco, Devang K. Sanghavi
The benefit of Inhaled nitric oxide (iNO) therapy in the setting of COVID-19-related ARDS is obscure. We performed a multicenter retrospective study to evaluate the impact of iNO on patients with COVID-19 who require respiratory support. This retrospective multicenter study included COVID-19 patients enrolled in the SCCM VIRUS COVID-19 registry who were admitted to different Mayo Clinic sites between March 2020 and June 2022 and required high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation (IMV). Patients were included in the ‘spontaneously breathing’ group if they remained non-intubated or were initiated on an HFNC (± NIV) before intubation. Patients who got intubated without prior use of an HFNC (± NIV) were included in the ‘intubated group.’ They were further divided into categories based on their iNO usage. Propensity score matching (PSM) and inverse propensity of treatment weighting (IPTW) were performed to examine outcomes. Among 2767 patients included in our analysis, 1879 belonged to spontaneously breathing (153 received iNO), and 888 belonged to the intubated group (193 received iNO). There was a consistent improvement in FiO2 requirement, P/F ratio, and respiratory rate within 48 h of iNO use among both spontaneously breathing and intubated groups. However, there was no significant difference in intubation risk with iNO use among spontaneously breathing patients (PSM OR 1.08, CI 0.71–1.65; IPTW OR 1.10, CI 0.90–1.33). In a time-to-event analysis using Cox proportional hazard model, spontaneously breathing patients initiated on iNO had a lower hazard ratio of in-hospital mortality (PSM HR 0.49, CI 0.32–0.75, IPTW HR 0.40, 95% CI 0.26–0.62) but intubated patients did not (PSM HR: 0.90; CI 0.66–1.24, IPTW HR 0.98, 95% CI 0.73–1.31). iNO use was associated with longer in-hospital stays, ICU stays, ventilation duration, and a higher incidence of creatinine rise. 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.
中文翻译:
低剂量吸入一氧化氮治疗对自主呼吸和插管 COVID-19 患者的影响:一项回顾性倾向匹配研究
吸入一氧化氮 (iNO) 治疗对 COVID-19 相关 ARDS 的益处尚不清楚。我们进行了一项多中心回顾性研究,以评估 iNO 对需要呼吸支持的 COVID-19 患者的影响。这项回顾性多中心研究包括参加 SCCM VIRUS COVID-19 登记的 COVID-19 患者,这些患者在 2020 年 3 月至 2022 年 6 月期间被梅奥诊所的不同院区收治,需要高流量鼻插管 (HFNC)、无创通气 (NIV) 或有创机械通气 (IMV)。如果患者在插管前保持未插管或开始使用 HFNC (± NIV),则被纳入“自主呼吸”组。之前未使用 HFNC (± NIV) 插管的患者被纳入“插管组”。它们根据其 iNO 使用情况进一步分为几类。进行倾向评分匹配 (PSM) 和治疗加权逆倾向 (IPTW) 以检查结果。在我们分析的 2767 例患者中,1879 例属于自主呼吸 (153 例接受 iNO),888 例属于插管组 (193 例接受 iNO)。自主呼吸组和插管组在使用 iNO 后 48 小时内 FiO2 需求、 P/F 比值和呼吸频率均持续改善。然而,在自主呼吸患者中,使用 iNO 的插管风险没有显著差异 (PSM OR 1.08,CI 0.71-1.65;IPTW OR 1.10,CI 0.90–1.33)。在使用 Cox 比例风险模型的时间事件分析中,开始使用 iNO 的自主呼吸患者的院内死亡率风险比较低 (PSM HR 0.49, CI 0.32-0.75, IPTW HR 0.40, 95% CI 0.26-0.62) 但插管患者没有 (PSM HR: 0.90;CI 0.66–1.24,IPTW HR 0。98,95% CI 0.73–1.31)。iNO 的使用与更长的住院时间、ICU 住院时间、通气时间和更高的肌酐升高发生率相关。这项回顾性倾向评分匹配研究表明,在事件发生时间分析中,使用 HFNC/NIV 支持的自主呼吸 COVID-19 患者使用 iNO 的院内死亡风险降低。插管和自主呼吸患者在 iNO 治疗下的氧合参数均有所改善,但与住院时间、ICU 住院时间、通气持续时间和肌酐升高发生率较高有关。
更新日期:2024-10-26
中文翻译:
低剂量吸入一氧化氮治疗对自主呼吸和插管 COVID-19 患者的影响:一项回顾性倾向匹配研究
吸入一氧化氮 (iNO) 治疗对 COVID-19 相关 ARDS 的益处尚不清楚。我们进行了一项多中心回顾性研究,以评估 iNO 对需要呼吸支持的 COVID-19 患者的影响。这项回顾性多中心研究包括参加 SCCM VIRUS COVID-19 登记的 COVID-19 患者,这些患者在 2020 年 3 月至 2022 年 6 月期间被梅奥诊所的不同院区收治,需要高流量鼻插管 (HFNC)、无创通气 (NIV) 或有创机械通气 (IMV)。如果患者在插管前保持未插管或开始使用 HFNC (± NIV),则被纳入“自主呼吸”组。之前未使用 HFNC (± NIV) 插管的患者被纳入“插管组”。它们根据其 iNO 使用情况进一步分为几类。进行倾向评分匹配 (PSM) 和治疗加权逆倾向 (IPTW) 以检查结果。在我们分析的 2767 例患者中,1879 例属于自主呼吸 (153 例接受 iNO),888 例属于插管组 (193 例接受 iNO)。自主呼吸组和插管组在使用 iNO 后 48 小时内 FiO2 需求、 P/F 比值和呼吸频率均持续改善。然而,在自主呼吸患者中,使用 iNO 的插管风险没有显著差异 (PSM OR 1.08,CI 0.71-1.65;IPTW OR 1.10,CI 0.90–1.33)。在使用 Cox 比例风险模型的时间事件分析中,开始使用 iNO 的自主呼吸患者的院内死亡率风险比较低 (PSM HR 0.49, CI 0.32-0.75, IPTW HR 0.40, 95% CI 0.26-0.62) 但插管患者没有 (PSM HR: 0.90;CI 0.66–1.24,IPTW HR 0。98,95% CI 0.73–1.31)。iNO 的使用与更长的住院时间、ICU 住院时间、通气时间和更高的肌酐升高发生率相关。这项回顾性倾向评分匹配研究表明,在事件发生时间分析中,使用 HFNC/NIV 支持的自主呼吸 COVID-19 患者使用 iNO 的院内死亡风险降低。插管和自主呼吸患者在 iNO 治疗下的氧合参数均有所改善,但与住院时间、ICU 住院时间、通气持续时间和肌酐升高发生率较高有关。