Use of almitrine in spontaneously breathing patients with COVID-19 treated with high-flow nasal cannula oxygen therapy and with persistent hypoxemia

Respiratory Research

Correspondence

Clément Saccheri¹  Romain Lombardi¹  Raphaël Devanlay¹  Hervé Hyvernat¹  Lucas Morand¹  Denis Doyen¹  Marie Juston¹  Émilie Panicucci¹  Jean Dellamonica¹  Mathieu Jozwiak¹ 

[1] Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L’Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France;Équipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d’Azur, Université Côte d’Azur, Nice, France;

关键词: Acute respiratory distress syndrome;    Awake prone positioning;    COVID-19;    Mechanical ventilation;    Oxygenation;   

DOI  :  10.1186/s12931-022-02308-y

 received in 2022-11-21, accepted in 2022-12-29,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAlmitrine, a selective pulmonary vasoconstrictor in hypoxic area, improves oxygenation in mechanically ventilated patients with COVID-19 but its effects in spontaneously breathing patients with COVID-19 remain to be determined.MethodsWe prospectively studied the effects of almitrine (16 µg/kg/min over 30 min followed by continuous administration in responders only) in 62 patients (66% of male, 63 [53–69] years old) with COVID-19 treated with high-flow nasal cannula oxygen therapy (HFNO) and with persistent hypoxemia, defined as a PaO2/FiO2 ratio < 100 with FiO2 > 80% after a single awake prone positioning session. Patients with an increase in PaO2/FiO2 ratio > 20% were considered as responders.ResultsOverall, almitrine increased the PaO2/FiO2 ratio by 50% (p < 0.01), decreased the partial arterial pressure of carbon dioxide by 7% (p = 0.01) whereas the respiratory rate remained unchanged and 46 (74%) patients were responders. No patient experienced right ventricular dysfunction or acute cor pulmonale. The proportion of responders was similar regardless of the CT-Scan radiological pattern: 71% for the pattern with predominant ground-glass opacities and 76% for the pattern with predominant consolidations (p = 0.65). Responders had lower intubation rate (33 vs. 88%, p < 0.01), higher ventilator-free days at 28-day (28 [20–28 ] vs. 19 [2–24] days, p < 0.01) and shorter ICU length of stay (5 [3–10] vs.12 [7–30] days, p < 0.01) than non-responders.ConclusionsAlmitrine could be an interesting therapy in spontaneously breathing patients with COVID-19 treated with HFNO and with persistent hypoxemia, given its effects on oxygenation without serious adverse effects regardless of the CT-Scan pattern, and potentially on intubation rate. These preliminary results need to be confirmed by further randomized studies.

【 授权许可】

CC BY   
© The Author(s) 2023

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