Sunday, November 27, 2022

Inhaled nitric oxide shortens hospital stay and improves oxygenation in pregnant patients with COVID-19 pneumonia

Newswise — BOSTON – High-dose inhaled nitric oxide gas (iNO) is a safe and effective respiratory therapy for pregnant women hospitalized with severe COVID-19 pneumonia, resulting in faster weaning from supplemental oxygen and reduced length of hospital stay, from according to a research team led by Massachusetts General Hospital (MGH). In a study published in obstetrics & gynecologyresearchers at four Boston hospitals reported that the addition of nitric oxide twice daily to standard oxygen therapy decreased the respiratory rate of pregnant women with low blood oxygen levels without causing side effects.

“To date, very few respiratory treatments to supplement supplemental oxygenation in pregnant patients with COVID-19 have been tested,” says senior author Lorenzo Berra, MD, Department of Anesthesia, Critical Care and Pain Medicine, MGH. “Investigators from all four medical centers that participated in our study agreed that the administration of high doses of nitric oxide via a snug-fitting mask has enormous potential as a novel therapeutic strategy for pregnant patients with COVID-19.”

Pneumonia triggered by COVID-19 is particularly threatening to pregnant women as it can rapidly progress to insufficient oxygen in the blood and body tissues, a condition known as hypoxemia, requiring hospitalization and cardiopulmonary support. “Compared with non-pregnant female patients with COVID-19, pregnant women are three times more likely to need intensive care unit admission, mechanical ventilation or advanced life support and four times more likely to die,” he notes. Carlo Valsecchi, MD, lead author in the Department of Anesthesia, Critical Care and Pain Medicine, MGH. “They also face a higher risk of obstetric complications such as preeclampsia, preterm birth and stillbirth.”

Nitric oxide is a therapeutic gas that was initially approved by the US Food and Drug Administration in 1999 for the inhalation treatment of intubated and mechanically ventilated neonates with hypoxic respiratory failure. With MGH conducting many early studies, iNO at high concentrations has also been shown to be effective as an antimicrobial in reducing the viral replication of SARS-CoV-1 and, more recently, SARS Co-V-2, the virus that causes COVID-19. 19. During the first wave of COVID-19, MGH treated six non-intubated pregnant patients with iNO at high doses of up to 200 parts per million (ppm). Findings of a more favorable outcome with iNO prompted MGH physicians to offer this treatment to other pregnant patients and to design the current study to determine the safety and efficacy of iNO200 for COVID-19 pneumonia in pregnancy.

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To this end, a collaborative network of four medical centers in the Boston area was formed. In addition to the MGH, it included Tufts Medical Center, Beth Israel Deaconess Medical Center, and Boston Medical Center. Researchers and clinicians from various departments – including critical care medicine, respiratory care and maternal fetal medicine – studied 71 pregnant patients with severe COVID-19 pneumonia admitted to these hospitals, 20 of whom received iNO200 twice daily. The study found that iNO therapy at this dosage, when compared to standard treatment alone, resulted in reductions in the need for supplemental oxygen and in hospital and ICU lengths of stay. No adverse events related to the intervention were reported in the mothers or their babies.

“Being able to wean patients off respiratory support more quickly could have other profound implications, including reducing stress for women and their families, decreasing the risk of hospital-acquired infections, and easing the burden on the healthcare system,” notes Berra. “Above all, our study supports the safety of high doses of nitric oxide in the pregnant population, and we hope that more clinicians will consider incorporating it into carefully monitored treatment regimens.”

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Berra is Associate Professor of Anesthesia at Harvard Medical School (HMS) and Medical Director of Respiratory Care at MGH. Valsecchi is a postdoctoral fellow and researcher at the Department of Anesthesia at MGH. Co-authors include William Barth, Jr., MD, Vice President of Obstetrics, MGH, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, HMS; Ai-ris Collier, MD, researcher and instructor in Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center; Ala Nozari, professor of Anesthesiology at Boston Medical Center; Jamel Ortoleva, MD, assistant professor of Anesthesiology at Tufts Medical School and cardiothoracic anesthetist and critical care physician at Tufts Medical Center; and Anjail Kaimal, MD, head of the Division of Maternal-Fetal Medicine, MGH, and associate professor of Obstetrics, Gynecology and Reproductive Biology, HMS.

About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the largest and original teaching hospital at Harvard Medical School. The Mass General Research Institute conducts the nation’s largest hospital research program, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working in more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the US News and World Report list of the “Best Hospitals in America”. MGH is a founding member of the Mass General Brigham Health System.

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