High-dose nitric oxide can reduce the length of hospital and ICU stay, as well as the need for supplemental oxygen, among women with COVID-19 pneumonia. The treatment is also not associated with adverse effects on newborns. The corresponding study was published in Obstetrics and Gynecology.
"Compared to 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," said Carlo Valsecchi, MD, lead author in the Department of Anesthesia, Critical Care and Pain Medicine, MGH. "They also face a greater risk of obstetric complications such as preeclampsia, preterm delivery, and stillbirth."
Nitric oxide was originally approved by the US Food and Drug Administration in 1999 for inhalation treatment of intubated and mechanically ventilated newborns with hypoxic respiratory failure. Recent reports demonstrated that high dose nitric oxide was linked to favorable outcomes among pregnant patients with COVID-19. As such, the researchers behind the present study decided to determine the safety and efficacy of high-dose nitric oxide for COVID-19 pneumonia in pregnancy.
To do so, they observed 71 pregnant patients with severe COVID-19 pneumonia. Twenty of the patients received 30 minutes of high dose nitric oxide twice per day in addition to standard of care, whereas the remaining 51 patients received standard of care alone. The researchers then noted how many days patients had free of oxygen supplementation 28 days postadmission.
In the end, they found that receiving high-dose nitric oxide was linked to 63.2% more days free from oxygen supplementation, a 59.7% shorter ICU length of stay, and a 63.6% shorter hospital length of stay than standard care alone.
"Being able to wean patients from respiratory support quicker could have other profound implications, including reducing stress on women and their families, lowering the risk of hospital-acquired infections, and relieving the burden on the health care system," said senior author Lorenzo Berra, MD, with the Department of Anesthesia, Critical Care and Pain Medicine, MGH.
"Above all, our study supports the safety of high dose nitric oxide in the pregnant population, and we hope more physicians will consider incorporating it into carefully monitored treatment regimens," he added.