PMID- 35915994
OWN - NLM
STAT- MEDLINE
DCOM- 20220913
LR  - 20221003
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Print)
IS  - 0885-0666 (Linking)
VI  - 37
IP  - 10
DP  - 2022 Oct
TI  - Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and 
      Meta-Analysis.
PG  - 1370-1382
LID - 10.1177/08850666221118271 [doi]
AB  - Introduction: Inhaled pulmonary vasodilators (IPVD) have been previously studied 
      in patients with non-coronavirus disease-19 (COVID-19) related acute respiratory 
      distress syndrome (ARDS). The use of IPVD has been shown to improve the partial 
      pressure of oxygen in arterial blood (PaO(2)), reduce fraction of inspired oxygen 
      (FiO(2)) requirements, and ultimately increase PaO(2)/FiO(2) (P/F) ratios in ARDS 
      patients. However, the role of IPVD in COVID-19 ARDS is still unclear. Therefore, 
      we performed this meta-analysis to evaluate the role of IPVD in COVID-19 
      patients. Methods: Comprehensive literature search of PubMed, Embase, Web of 
      Science and Cochrane Library databases from inception through April 22, 2022 was 
      performed for all published studies that utilized IPVD in COVID-19 ARDS patients. 
      The single arm studies and case series were combined for a 1-arm meta-analysis, 
      and the 2-arm studies were combined for a 2-arm meta-analysis. Primary outcomes 
      for the 1-arm and 2-arm meta-analyzes were change in pre- and post-IPVD P/F 
      ratios and mortality, respectively. Secondary outcomes for the 1-arm 
      meta-analysis were change in pre- and post-IPVD positive end-expiratory pressure 
      (PEEP) and lung compliance, and for the 2-arm meta-analysis the secondary 
      outcomes were need for endotracheal intubation and hospital length of stay (LOS). 
      Results: 13 single arm retrospective studies and 5 case series involving 613 
      patients were included in the 1-arm meta-analysis. 3 studies involving 640 
      patients were included in the 2-arm meta-analysis. The pre-IPVD P/F ratios were 
      significantly lower compared to post-IPVD, but there was no significant 
      difference between pre- and post-IPVD PEEP and lung compliance. The mortality 
      rates, need for endotracheal intubation, and hospital LOS were similar between 
      the IPVD and standard therapy groups. Conclusion: Although IPVD may improve 
      oxygenation, our investigation showed no benefits in terms of mortality compared 
      to standard therapy alone. However, randomized controlled trials are warranted to 
      validate our findings.
FAU - Khokher, Waleed
AU  - Khokher W
AUID- ORCID: 0000-0001-9539-5583
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Malhas, Saif-Eddin
AU  - Malhas SE
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Beran, Azizullah
AU  - Beran A
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Iftikhar, Saffa
AU  - Iftikhar S
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Burmeister, Cameron
AU  - Burmeister C
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Mhanna, Mohammed
AU  - Mhanna M
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Srour, Omar
AU  - Srour O
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Rashid, Rakin
AU  - Rashid R
AD  - Department of Internal Medicine, 22519Mercy Catholic Medical Center, Darby, PA, 
      USA.
FAU - Kesireddy, Nithin
AU  - Kesireddy N
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
FAU - Assaly, Ragheb
AU  - Assaly R
AD  - Department of Internal Medicine, 89021University of Toledo, Toledo, OH, USA.
AD  - Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, 
      OH, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20220802
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Vasodilator Agents)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - *COVID-19
MH  - Humans
MH  - Oxygen
MH  - *Respiratory Distress Syndrome/drug therapy
MH  - Retrospective Studies
MH  - Vasodilator Agents/therapeutic use
PMC - PMC9346441
OTO - NOTNLM
OT  - COVID-19
OT  - inhaled pulmonary vasodilators
OT  - intubation
OT  - mortality
OT  - refractory hypoxia
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2022/08/03 06:00
MHDA- 2022/09/14 06:00
PMCR- 2022/10/01
CRDT- 2022/08/02 03:22
PHST- 2022/08/03 06:00 [pubmed]
PHST- 2022/09/14 06:00 [medline]
PHST- 2022/08/02 03:22 [entrez]
PHST- 2022/10/01 00:00 [pmc-release]
AID - 10.1177_08850666221118271 [pii]
AID - 10.1177/08850666221118271 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2022 Oct;37(10):1370-1382. doi: 10.1177/08850666221118271. 
      Epub 2022 Aug 2.