Open Access

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

Komal Imtiaz
Komal Imtiaz
, 
Wade Jodeh
Wade Jodeh
, 
Dave Sudekum
Dave Sudekum
, 
Bruno DiGiovine
Bruno DiGiovine
 and 
Jason Hecht
Jason Hecht
   | Nov 17, 2021
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Article Category: Case report
Published Online: Nov 17, 2021
Page range: 33 - 40
Received: Nov 24, 2020
Accepted: Sep 27, 2021
DOI: https://doi.org/10.2478/jccm-2021-0037
Keywords
© 2022 Komal Imtiaz, Wade Jodeh, Dave Sudekum, Bruno DiGiovine, Jason Hecht, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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 ± 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)

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%)

Hospital Outcomes

Epoprostenol (N=12)
Hospital Mortality, no (%) 10 (66.7)
Time to first MV wean, hours ± SD 6.8 ± 5.6
Time to Extubation, days ± SD 9.9 ± 1.2
Days of Therapy, days ± SD 3.1 ± 1.6
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