Before the extreme anti-vax harpies descend on you I’d like to ask a question about treatment.
Nitric oxide was an effective treatment for covid1, and there was a study of it by Mass General Hosp in pregnant women early last year that had good results. And good studies by MGH and others since.
Now in phase 3 trials.
Is it a very difficult, expensive treatment that hosps are not set up for?
I believe that this is the “disinfectant” that Trump referred to in the early days.
Thank you first for your kindness and your question.
Inhaled nitric oxide has been used since I was in fellowship and residency 20 years ago. Nitric oxide is technically an endothelial relaxing agent and vasodilator which was originally thought to reduce the distance the oxygen was required to diffuse across the capillary bed to the blood stream from the alveolus (high level view — I am sure that some of the more vocal fact checkers will try to say there are technical inaccuracies — technically it provides selective pulmonary vasodilation in well ventilated lung units which improves VQ mismatch).
However, the literature and clinical practice demonstrate that the effect is relatively fleeting and there is no improvement at 30 day mortality, although there are higher PaO2 on ABG for a couple of days. It is quite expensive and relatively ineffective in terms of mortality data
What we have learned is that prone ventilation is far more important and far earlier. Currently in all ARDS (not only CoVID ARDS) If the Pa/Fi gradient is < 150:1, I initiate prone ventilation which has had positive results. I think what will come from this pandemic as it runs its course is understanding the best treatments for ARDS — recalling that ARDS is a nonspecific finding to a disease process.