We conducted an observation sub-study of the prospective randomized controlled trial"High Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure", in which weanalysed the echocardiographic data collected both at baseline when patients whereincluded and 3-5 days later for followup.
We conducted an observation sub-study of the prospective randomized controlled trial
"High Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure" which was
conducted in 2020/2021 during the COVID-19 pandemic on patients with ARDS due to COVID
and requiring mechanical ventialtion. Patients underwent echocardiography at baseline,
and were then randomized either to control, or treatment with inhaled nitric oxide,
starting at 80ppm and then 40ppm. Followup echocardiography was performed 3-5 days later,
and all echocardiographies were conducted by highly experienced sonographeres certified
by the European Association of Cardiovascular Imaging. Analysis of these cardiac
ultrasounds focused on the amount of patients showing signs of pulmonary hypertension,
right ventricular failure and left ventricular failure. Several parameters were used to
estimate these, and we also aimed to evalute the utility of more novel measures such as
RV and LV GLS for this use in the ICU.
Inclusion Criteria:
- Age ≥18.
- Positive PCR for COVID-19.
- Admission to the ICU.
- Endotracheal intubation and mechanical ventilation.
- Severe hypoxemia, defined by PaO2/FiO2 < 300 mmHg.
- Inclusion in the trial "High Dose Inhaled Nitric Oxide in Acute Hypoxemic
Respiratory Failure"
Exclusion Criteria:
- Endotracheal intubation for >72h before inclusion.
- Do not resuscitate order or other limitation of care.
- Known pregnancy.
- Cases where the treating physician opposes inclusion due to safety concerns or
considerations that renders inclusion unfeasible.
- Not having had echocardiography performed during the trial period (exclusion
criteria for this sub-study).
Danderyds Hospital
Stockholm 2673730, Sweden
Daniel Törnberg, MD PhD, Study Director
KI DS