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The Use of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome Secondary due to COVID-19: A Case Series Cover

The Use of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome Secondary due to COVID-19: A Case Series

Open Access
|Nov 2021

Figures & Tables

Fig. 1

Study PopulationAbbreviations: COVID-19, coronavirus disease 2019; iEpo, inhaled epoprostenol; ECMO, extracorporeal membrance oxygenation; ABG, arterial blood gas
Study PopulationAbbreviations: COVID-19, coronavirus disease 2019; iEpo, inhaled epoprostenol; ECMO, extracorporeal membrance oxygenation; ABG, arterial blood gas

Fig. 2

P/F Ratio Following Initiation. Black line represents median; X, means; box ends, interquartile ranges; capped end lines, maximum and minimum valuesAbbreviations: P/F, Pa02 / FiO2.
P/F Ratio Following Initiation. Black line represents median; X, means; box ends, interquartile ranges; capped end lines, maximum and minimum valuesAbbreviations: P/F, Pa02 / FiO2.

Baseline Characteristics Prior to Initiation

Epoprostenol (N=15)
Age, years ± SD57.2 ± 13.7

Male, No (%)11 (73.3)

BMI, kg/m2 ± SD33.0 ± 10.9

SOFA score, ± SD8.9 ± 3.3

COVID-19 Treatments
    Hydroxychloroquine12 (80.0)
    Tocilizumab4 (26.7)
    Corticosteroids13 (86.7)
    Convalescent Plasma3 (20.0)
    Remdesevir5 (33.3)

Vasopressor, No (%)13 (86.7)

Ventilator Status, No (%)
    VC/AC4 (26.7)
    PC/AC10 (66.7)
    APRV1 (6.7)
    Prone11 (73.3)
    Paralyzed6 (40.0)
    Arterial Blood Gas
    FiO2, % ± SD91.3 ± 13.4
    PEEP, cm H20 ± SD13.7 ± 3.3
    pH, ± SD7.33 ± 0.1
    pCO2, mmHg ± SD48.8 ± 12.4
    Pa02, mmHg ± SD84.7 ± 33.2
    P/F Ratio, mmHg ± SD95.9 ± 42.0

Comorbidities, No (%)
    Asthma2 (13.3)
    COPD0 (0.0)
    CAD4 (26.7)
    Diabetes6 (40.0)
    Immunocompromised3 (20.0)

Clinical Data for Fifteen Inhaled Epoprostenol Patients

Patient123456789101112131415Summary
Prior to InitiationProneNoNoYesYesNoYesYesYesYesNoYesYesYesYesYes11 (73%)
ParalyzedNoNoNoNoNoYesYesNoNoYesYesYesNoNoYes6 (40%)
ModePC/ACPC/ACPC/ACVC/ACVC/ACAPRVPC/ACPC/ACPC/ACVC/ACVC/ACPC/ACPC/ACPC/ACPC/AC-
FiO2 (%)75100907060100100100801001009510010010091.3
PEEP (cm H2O)18121520101212141410121215102013.7
PaO2 (mmHg)119895392681414872136468968431297784.7
P/F (mmHg)15989591311131414872170468972431297795.9

Following InitiationProneNoNoYesNoNoDeceased prior to additional labsNoYesYesNoNoYesYesYesYes7 (47%)
ParalyzedNoNoNoNoNoNoNoNoNoNoYesYesNoYes3 (20%)
ModeVC/ACPC/ACAPRVPC/ACVC/ACAPRVPC/ACPC/ACVC/ACVC/ACPC/ACPC/ACPC/ACPC/AC-
FiO 2 (%)50100100708010080701004095958510083.2
PEEP (cm H2O)121430201013141610121215102415.1
PaO2 (mmHg)992126520162605589645273739710893.6
P/F (mmHg)19821265287786069127641307777114108119.0
Time Wean to (hours) first MV8218.512.12.3N/A130.26N/A4.4 35.3N/A6.8
Time to Extubation (days)9.211.08.7N/AN/AN/AN/AN/AN/A10.8N/AN/A*N/A N/A9.9
Days of Therapy53337125321 4N/A*23.1
MortalityNoNoNoYesYesYesYesYesYesYesYes Yes Yes10 (67%)

Hospital Outcomes

Epoprostenol (N=12)
Hospital Mortality, no (%)10 (66.7)
Time to first MV wean, hours ± SD6.8 ± 5.6
Time to Extubation, days ± SD9.9 ± 1.2
Days of Therapy, days ± SD3.1 ± 1.6
DOI: https://doi.org/10.2478/jccm-2021-0037 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 33 - 40
Submitted on: Nov 24, 2020
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Accepted on: Sep 27, 2021
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Published on: Nov 17, 2021
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2021 Komal Imtiaz, Wade Jodeh, Dave Sudekum, Bruno DiGiovine, Jason Hecht, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.