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. 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

Andrew P Michelson  1 , Patrick G Lyons  2 , Nguyet M Nguyen  2 , Daniel Reynolds  2 , Rachel McDonald  2 , Colleen A McEvoy  2 , Vladimir Despotovic  2 , Steven L Brody  2 , Marin H Kollef  2 , Bryan D Kraft  2
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.

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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.
See this image and copyright information in PMC

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