Pharmacotherapy Considerations in Hospitalized Patients With COVID-19 Pneumonia

William Pruett, MD; Lee E. Morrow, MD, MSc, FCP, FCCP, FCCM, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS


US Pharmacist. 2020;45(44020):HS9-HS16. 

In This Article

Other Therapies

Certain other therapies are considerations for institutions with the experience and capability to successfully employ them. Inhaled pulmonary vasodilators (nebulized epoprostenol, inhaled nitric oxide) are agents with a short half-life that, when delivered via the ventilator, cause vasodilation only in alveoli that are functional and participating in gas exchange. This effectively shunts blood flow away from atelectatic and consolidated alveoli and redirects it to functioning alveoli, thereby resulting in improved ventilation-perfusion matching and improved blood oxygenation. These medications have mixed recommendations because they are labor intensive; they accelerate the rate of replacement of ventilator filters, a potentially limited resource; tachyphylaxis develops; and their ability to improve oxygenation has never translated into improved clinical outcomes. Existing guidelines vary in their recommendations on the use of these medications, including using them as a temporary measure or as a bridge to extracorporeal membrane oxygenation (ECMO) treatment and making no comment on their use.[5,6,16,32] The clinical pharmacist should ensure that these medications are used only in the appropriate clinical context by experienced prescribers.

The use of ECMO as salvage therapy in severe COVID-19 is controversial, as this is a personnel- and resource-rich endeavor that simply might not be practicable during times of COVID-19 surge. However, several guidelines endorse its consideration if it is available and feasible.[6,15,16,24,32]