Prognostic Value of Response to Inhaled Nitric Oxide Administration in Patients with Acute Respiratory Distress Syndrome Related to Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Indian Journal of Respiratory Care (2024): 10.5005/jp-journals-11010-1134

Pasquale Baratta , Francesco De Sensi , Alberto Cresti , Bruno Sposato , Rosa Buontempo , Genni Spargi , Ugo Limbruno.

Ab s t r ac t

Background: The role of inhaled nitric oxide (iNO) in managing acute respiratory distress syndrome COVID-19 related (C-ARDS) is debatable. The study aimed to analyze the effect of iNO administration in patients with persistent severe hypoxia and intensive care unit (ICU) mortality. Materials and methods: This retrospective study included 196 consecutive critically ill patients with C-ARDS admitted to ICU from 1 October 2020 to 31 October 2021. Results: Of these patients, 28% had received iNO. Twenty-four (44.4%) were responders. Kaplan–Meier plot shows mortality was higher in nonresponders (86.6 vs 25.0%). Nonresponse to iNo was the most important predictive value (p = 0.01). The receiver operating characteristic (ROC) curve for a percentage increase in partial pressure of oxygen (PaO2) from baseline confirmed that it had a higher predictive value for inhospital survival. A value of 19% can predict the death event with a sensitivity of 81.8% and a specificity of 81.2%. Conclusion: Therefore, we propose to use iNO as a vasoreactivity test for prognostic stratification in patients with persistent severe hypoxia.