What is the role of nitric oxide in the treatment of coronavirus disease 2019 (COVID-19)?

Updated: Jan 14, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Published findings from the 2004 SARS-CoV infection suggest the potential role of inhaled nitric oxide (iNO; Mallinckrodt Pharmaceuticals, plc) as a supportive measure for treating infection in patients with pulmonary complications. Treatment with iNO reversed pulmonary hypertension, improved severe hypoxia, and shortened the length of ventilatory support compared with matched control patients with SARS.

The phase 3 study (COViNOX) for iNO (INOpulse; Bellerophon Therapeutics) for patients with mild-to-moderate COVID-19 who are hospitalized and require supplemental oxygen has been put on hold after interim analysis from the first 100 patients. The study has recruited nearly 200 patients as of November 2020. [298] The Society of Critical Care Medicine recommends against the routine use of iNO in patients with COVID-19 pneumonia. Instead, they suggest a trial only in mechanically ventilated patients with severe ARDS and hypoxemia despite other rescue strategies. [274] The cost of iNO is reported as exceeding $100/hour. 

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