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
. 2023 Dec;1(3):100019.
doi: 10.1016/j.chstcc.2023.100019. Epub 2023 Sep 25.

Use of Inhaled Epoprostenol in Patients With COVID-19 Receiving Humidified, High-Flow Nasal Oxygen Is Associated With Progressive Respiratory Failure

Affiliations

Use of Inhaled Epoprostenol in Patients With COVID-19 Receiving Humidified, High-Flow Nasal Oxygen Is Associated With Progressive Respiratory Failure

Andrew P Michelson et al. CHEST Crit Care. 2023 Dec.

Abstract

Background: The clinical benefit of using inhaled epoprostenol (iEpo) through a humidified high-flow nasal cannula (HHFNC) remains unknown for patients with COVID-19.

Research question: Can iEpo prevent respiratory deterioration for patients with positive SARS-CoV-2 findings receiving HHFNC?

Study design and methods: This multicenter retrospective cohort analysis included patients aged 18 years or older with COVID-19 pneumonia who required HHFNC treatment. Patients who received iEpo were propensity score matched to patients who did not receive iEpo. The primary outcome was time to mechanical ventilation or death without mechanical ventilation and was assessed using Kaplan-Meier curves and Cox proportional hazard ratios. The effects of residual confounding were assessed using a multilevel analysis, and a secondary analysis adjusted for outcome propensity also was performed in a multivariable model that included the entire (unmatched) patient cohort.

Results: Among 954 patients with positive SARS-CoV-2 findings receiving HHFNC therapy, 133 patients (13.9%) received iEpo. After propensity score matching, the median number of days until the composite outcome was similar between treatment groups (iEpo: 5.0 days [interquartile range, 2.0-10.0 days] vs no-iEpo: 6.5 days [interquartile range, 2.0-11.0 days]; P = .26), but patients who received iEpo were more likely to meet the composite outcome in the propensity score-matched, multilevel, and multivariable unmatched analyses (hazard ratio, 2.08 [95% CI, 1.73-2.50]; OR, 4.72 [95% CI, 3.01-7.41]; and OR, 1.35 [95% CI, 1.23-1.49]; respectively).

Interpretation: In patients with COVID-19 receiving HHFNC therapy, use of iEpo was associated with the need for invasive mechanical ventilation.

Keywords: ARDS; Acute respiratory distress syndrome; COVID-19; SARS-CoV-2; humidified high-flow nasal cannula; inhaled epoprostenol; inhaled pulmonary vasodilators.

PubMed Disclaimer

Figures

Figure 1 –
Figure 1 –
Flow diagram showing patient cohort. HHFNC = high-humidity nasal cannula; iEpo = inhaled epoprostenol.
Figure 2 –
Figure 2 –
Kaplan-Meier curve depicting time to the composite outcome of time to mechanical ventilation or death without mechanical ventilation for patients initiated on HHFNC therapy who received inhaled epoprostenol as well as the matched control participants who did not receive inhaled epoprostenol. HHFNC = humidified high-flow nasal cannula; HR = hazard ratio.

Similar articles

Cited by

References

    1. Fuller BM, Mohr NM, Skrupky L, Fowler S, Kollef MH, Carpenter CR. The use of inhaled prostaglandins in patients with ARDS. Chest. 2015;147(6):1510–1522. - PMC - PubMed
    1. Afshari A, Bille AB, Allingstrup M. Aerosolized prostacyclins for acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev. 2017;2018(7):CD007733. - PMC - PubMed
    1. van Heerden PV, Barden A, Michalopoulos N, Bulsara MK, Roberts BL. Dose-response to inhaled aerosolized prostacyclin for hypoxemia due to ARDS. Chest. 2000;117(3):819–827. - PubMed
    1. Dahlem P, van Aalderen WMC, de Neef M, Dijkgraaf MGW, Bos AP. Randomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury. Crit Care Med. 2004;32(4):1055–1060. - PubMed
    1. Hahla S, Nawal S, Salwa Z, Muniza Y, Iqbal A, Anwarul HG. Use of inhaled PGE1 to improve diastolic dysfunction, LVEDP, pulmonary hypertension and hypoxia in ARDS—a randomised clinical trial. Open J Anesthesiol. 2013;03(02):109–115.