Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021:32:101358.
doi: 10.1016/j.rmcr.2021.101358. Epub 2021 Jan 30.

COVID-19 acute respiratory distress syndrome: can iloprost have a role for the treatment?

Alida Filippini  1 , Claudio Bnà  2 , Raffaello Bellosta  3 , Roberto Bazzani  1 , Luca Luzzani  3 , Matteo Alberto Pegorer  3 , Matteo Zandalasini  4 , Michela Baldon  4 , Manuela Codazzi  5 , Tony Sabatini  1
Affiliations
Case Reports

COVID-19 acute respiratory distress syndrome: can iloprost have a role for the treatment?

Alida Filippini et al. Respir Med Case Rep. 2021.

Abstract

Pulmonary infection of 2019-nCoV can frequently induce acute respiratory distress syndrome (ARDS) with partial pressure of arterial oxygen/fraction of inspired oxygen ratio (pO2/FiO2) of less than 300 mmHg. Moreover, it can be complicated with cardiac injury or arrhythmia, microvascular and large-vessel thrombosis. We describe a case of a patient with COVID19-ARDS and concomitant critical ischemia of the limbs. Iloprost treatment, an analogue of a prostacyclin PGI2, was started for residual left forefoot ischemia after surgical thromboembolectomy. Unexpectedly, we documented improvement of respiratory performance and lung high resolution computed tomography (HRCT) showed significant regression of the diffuse pulmonary ground-glass opacity. The hypothetical mechanism is that iloprost can enhance perfusion preferentially to well-ventilated lung regions, reduce pressures of peripheral pulmonary vessels and induce reduction of lung interstitial edema. In addition, iloprost antithrombotic effect, endothelial damage repairing and neo-angiogenesis activity could play a relevant role.

Keywords: ARDS; ARDS, acute respiratory distress syndrome; COVID-19 infection; FiO2, fraction of inspired oxygen; HRCT, high resolution computed tomography; Iloprost; PEEP, positive end expiratory pressure; SpO2, oxygen peripheral saturation; pO2, partial pressure of arterial oxygen.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a–b. HRCT chest images of patient with COVID-19 ARDS.The HRCT chest images shown muitifocal, bilatergal ground-glass opactity, interlobular septal thickening and ilatergal infiltrates, involving 50–75% of the lung parenchyma, without adenopathy and pleural effusion.
Fig. 2
Fig. 2
c–d: HRC of the chest after three days of iloprost treatment. Control HRC of the chest show a significant regression of the diffuse ground-glass with higher percentage of areated areas, and some bilateral consolidation with air-bronchogram and bronchiolectasis, more represented in peripheral areas of the iungs.
See this image and copyright information in PMC

References

    1. Matthay M.A., Ware L.B., Zimmerman G.A. The acute respiratory distress syndrome. J. Clin. Invest. 2012;122(8):2731–2740. - PMC - PubMed
    1. Haeberle H., Prohaska S., Martus P. Therapeutic iloprost for the treatment of acute respiratory distress syndrome (ARDS) (th Thllo trial): a prospective, randomized, multicenter phase II study. Trials. 2020;21:242. - PMC - PubMed
    1. Newsomea A.S., Sultana s, Murray B. Effect of inhaled iloprost on gas exchange in inhalation injury. Burns Open. October 2017;1(Issue 2):49–53.
    1. Afshari A., Bastholm Bille A., Allingstrup M. Aerosolized prostacyclins for acute respiratory distress syndrome (ARDS) Cochrane Database Syst. Rev. 2017;7:CD007733. - PMC - PubMed
    1. Sawheny E., Ellis A.L., Kinasewitz G.T. Iloprost improves gas exchange in patients with pulmonary hypertension and ARDS. Chest. 2013;144(1):55–62. - PubMed

Publication types