Fig. 1
Study Population
Abbreviations: COVID-19, coronavirus disease 2019; iEpo, inhaled epoprostenol; ECMO, extracorporeal membrance oxygenation; ABG, arterial blood gas
Table 1
Baseline Characteristics Prior to Initiation
| Epoprostenol (N=15) | |
|---|---|
| Age, years ± SD | 57.2 ± 13.7 |
| Male, No (%) | 11 (73.3) |
| BMI, kg/m2 ± SD | 33.0 ± 10.9 |
| SOFA score, ± SD | 8.9 ± 3.3 |
| COVID-19 Treatments | |
| Hydroxychloroquine | 12 (80.0) |
| Tocilizumab | 4 (26.7) |
| Corticosteroids | 13 (86.7) |
| Convalescent Plasma | 3 (20.0) |
| Remdesevir | 5 (33.3) |
| Vasopressor, No (%) | 13 (86.7) |
| Ventilator Status, No (%) | |
| VC/AC | 4 (26.7) |
| PC/AC | 10 (66.7) |
| APRV | 1 (6.7) |
| Prone | 11 (73.3) |
| Paralyzed | 6 (40.0) |
| Arterial Blood Gas | |
| FiO2, % ± SD | 91.3 ± 13.4 |
| PEEP, cm H20 ± SD | 13.7 ± 3.3 |
| pH, ± SD | 7.33 ± 0.1 |
| pCO2, mmHg ± SD | 48.8 ± 12.4 |
| Pa02, mmHg ± SD | 84.7 ± 33.2 |
| P/F Ratio, mmHg ± SD | 95.9 ± 42.0 |
| Comorbidities, No (%) | |
| Asthma | 2 (13.3) |
| COPD | 0 (0.0) |
| CAD | 4 (26.7) |
| Diabetes | 6 (40.0) |
| Immunocompromised | 3 (20.0) |
[i] Abbreviations: SD, standard deviation; BMI, body mass index; SOFA, sequential organ failure assessment; COVID-19, Coronavirus Disease 2019; VC/AC, volume control assist control; PC/AC, pressure control assist control; APRV, airway pressure release ventilation; Fi02, fraction of inspired oxygen; PEEP, positive end expiratory pressure; pCO2; partial pressure of carbon dioxide; mmHg, millimeters of mercury; Pa02, partial pressure of oxygen; P/F, Pa02/Fi02; COPD, chronic obstructive pulmonary disease; CAD, coronary artery disease
Table 2
Clinical Data for Fifteen Inhaled Epoprostenol Patients
| Patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | Summary | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Prior to Initiation | Prone | No | No | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 11 (73%) |
| Paralyzed | No | No | No | No | No | Yes | Yes | No | No | Yes | Yes | Yes | No | No | Yes | 6 (40%) | |
| Mode | PC/AC | PC/AC | PC/AC | VC/AC | VC/AC | APRV | PC/AC | PC/AC | PC/AC | VC/AC | VC/AC | PC/AC | PC/AC | PC/AC | PC/AC | - | |
| FiO2 (%) | 75 | 100 | 90 | 70 | 60 | 100 | 100 | 100 | 80 | 100 | 100 | 95 | 100 | 100 | 100 | 91.3 | |
| PEEP (cm H2O) | 18 | 12 | 15 | 20 | 10 | 12 | 12 | 14 | 14 | 10 | 12 | 12 | 15 | 10 | 20 | 13.7 | |
| PaO2 (mmHg) | 119 | 89 | 53 | 92 | 68 | 141 | 48 | 72 | 136 | 46 | 89 | 68 | 43 | 129 | 77 | 84.7 | |
| P/F (mmHg) | 159 | 89 | 59 | 131 | 113 | 141 | 48 | 72 | 170 | 46 | 89 | 72 | 43 | 129 | 77 | 95.9 | |
| Following Initiation | Prone | No | No | Yes | No | No | Deceased prior to additional labs | No | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 7 (47%) |
| Paralyzed | No | No | No | No | No | No | No | No | No | No | Yes | Yes | No | Yes | 3 (20%) | ||
| Mode | VC/AC | PC/AC | APRV | PC/AC | VC/AC | APRV | PC/AC | PC/AC | VC/AC | VC/AC | PC/AC | PC/AC | PC/AC | PC/AC | - | ||
| FiO 2 (%) | 50 | 100 | 100 | 70 | 80 | 100 | 80 | 70 | 100 | 40 | 95 | 95 | 85 | 100 | 83.2 | ||
| PEEP (cm H2O) | 12 | 14 | 30 | 20 | 10 | 13 | 14 | 16 | 10 | 12 | 12 | 15 | 10 | 24 | 15.1 | ||
| PaO2 (mmHg) | 99 | 212 | 65 | 201 | 62 | 60 | 55 | 89 | 64 | 52 | 73 | 73 | 97 | 108 | 93.6 | ||
| P/F (mmHg) | 198 | 212 | 65 | 287 | 78 | 60 | 69 | 127 | 64 | 130 | 77 | 77 | 114 | 108 | 119.0 | ||
| Time Wean to (hours) first MV | 8 | 2 | 18.5 | 12.1 | 2.3 | N/A | 13 | 0.2 | 6 | N/A | 4.4 | 3 | 5.3 | N/A | 6.8 | ||
| Time to Extubation (days) | 9.2 | 11.0 | 8.7 | N/A | N/A | N/A | N/A | N/A | N/A | 10.8 | N/A | N/A* | N/A | N/A | 9.9 | ||
| Days of Therapy | 5 | 3 | 3 | 3 | 7 | 1 | 2 | 5 | 3 | 2 | 1 | 4 | N/A* | 2 | 3.1 | ||
| Mortality | No | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 (67%) |
[i] * Transferred to ECMO center therefore data unavailable
Abbreviations: PC/AC, pressure control assist control; VC/AC, volume control assist control; APRV, airway pressure release ventilation; FiO2, fraction of inspired oxygen; PEEP, positive end expiratory pressure; pCO2; partial pressure of carbon dioxide; mmHg, millimeters of mercury; PaO2, partial pressure of oxygen; P/F, PaO2/FiO2
Fig. 2
P/F Ratio Following Initiation. Black line represents median; X, means; box ends, interquartile ranges; capped end lines, maximum and minimum values
Abbreviations: P/F, Pa02 / FiO2.