Editorial & Opinion
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Use of almitrine in spontaneously breathing patients with COVID-19 treated with high-flow nasal cannula oxygen therapy and with persistent hypoxemia.
المؤلفون: Saccheri C; 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., Morand L; 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., Juston M; 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., Doyen D; 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., Hyvernat H; 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., Lombardi R; 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., Devanlay R; 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., Panicucci É; 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., Dellamonica J; 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., Jozwiak M; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France. jozwiak.m@chu-nice.fr.; Équipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France. jozwiak.m@chu-nice.fr.
المصدر: Respiratory research [Respir Res] 2023 Jan 05; Vol. 24 (1), pp. 1. Date of Electronic Publication: 2023 Jan 05.
نوع المنشور: Letter
اللغة: English
بيانات الدورية: Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 101090633 Publication Model: Electronic Cited Medium: Internet ISSN: 1465-993X (Electronic) Linking ISSN: 14659921 NLM ISO Abbreviation: Respir Res Subsets: MEDLINE
أسماء مطبوعة: Publication: 2001- : London : BioMed Central Ltd.
Original Publication: London : Current Science Ltd., c2000-
مواضيع طبية MeSH: COVID-19*/therapy , Respiratory Distress Syndrome*/therapy, Humans ; Male ; Middle Aged ; Aged ; Almitrine ; Cannula ; Hypoxia/diagnosis ; Hypoxia/therapy ; Oxygen
مستخلص: Background: Almitrine, 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.
Methods: We 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 PaO 2 /FiO 2 ratio < 100 with FiO 2  > 80% after a single awake prone positioning session. Patients with an increase in PaO 2 /FiO 2 ratio > 20% were considered as responders.
Results: Overall, almitrine increased the PaO 2 /FiO 2 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.
Conclusions: Almitrine 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.
(© 2023. The Author(s).)
References: Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300. (PMID: 32228035)
EClinicalMedicine. 2022 Oct;52:101663. (PMID: 36157895)
JAMA. 2020 Mar 17;323(11):1061-1069. (PMID: 32031570)
Ann Intensive Care. 2020 Nov 4;10(1):151. (PMID: 33150525)
Lancet. 2007 Oct 20;370(9596):1453-7. (PMID: 18064739)
Thorax. 1989 Apr;44(4):247-50. (PMID: 2548298)
Am J Respir Crit Care Med. 2019 Jun 1;199(11):1368-1376. (PMID: 30576221)
Lancet Infect Dis. 2020 Dec;20(12):1365-1366. (PMID: 32359410)
N Engl J Med. 2015 Jun 4;372(23):2185-96. (PMID: 25981908)
Lancet. 2020 Feb 15;395(10223):507-513. (PMID: 32007143)
Crit Care. 2020 Jul 6;24(1):395. (PMID: 32631389)
Intensive Care Med. 2020 May;46(5):854-887. (PMID: 32222812)
Circulation. 2020 Jul 14;142(2):101-104. (PMID: 32369390)
Intensive Care Med. 2020 Jun;46(6):1099-1102. (PMID: 32291463)
Front Med (Lausanne). 2021 Jul 01;8:655763. (PMID: 34277653)
Lancet Respir Med. 2022 Jul;10(7):641-649. (PMID: 35325620)
Lancet Respir Med. 2021 Dec;9(12):1387-1395. (PMID: 34425070)
Crit Care Med. 2021 Feb 1;49(2):e191-e198. (PMID: 33093279)
Ann Transl Med. 2020 Jul;8(14):878. (PMID: 32793722)
Eur Radiol. 2020 Sep;30(9):4903-4909. (PMID: 32314058)
Eur Radiol. 2020 Aug;30(8):4381-4389. (PMID: 32193638)
Anesthesiology. 1998 Oct;89(4):823-30. (PMID: 9777998)
Intensive Care Med. 1994;20(4):254-9. (PMID: 8046118)
Intensive Care Med. 2021 Jan;47(1):60-73. (PMID: 33211135)
Lancet. 2020 Feb 15;395(10223):497-506. (PMID: 31986264)
Am J Respir Crit Care Med. 1998 Dec;158(6):1770-7. (PMID: 9847266)
Radiographics. 2013 Nov-Dec;33(7):1951-75. (PMID: 24224590)
Anesthesiology. 1995 Nov;83(5):929-43. (PMID: 7486178)
Mol Pharmacol. 1998 Feb;53(2):330-9. (PMID: 9463492)
Ann Intensive Care. 2019 Jun 13;9(1):69. (PMID: 31197492)
Eur J Heart Fail. 2020 Dec;22(12):2228-2237. (PMID: 33200458)
Intensive Care Med. 2001 Nov;27(11):1737-43. (PMID: 11810116)
Chest. 2020 Nov;158(5):2003-2006. (PMID: 32512007)
Intensive Care Med. 1997 Sep;23(9):1008. (PMID: 9347377)
فهرسة مساهمة: Keywords: Acute respiratory distress syndrome; Awake prone positioning; COVID-19; Mechanical ventilation; Oxygenation
المشرفين على المادة: 9A1222NBG4 (Almitrine)
S88TT14065 (Oxygen)
تواريخ الأحداث: Date Created: 20230104 Date Completed: 20230106 Latest Revision: 20230111
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC9812745
DOI: 10.1186/s12931-022-02308-y
PMID: 36600234
قاعدة البيانات: MEDLINE
الوصف
تدمد:1465-993X
DOI:10.1186/s12931-022-02308-y