Saturday, February 2, 2019

Inhaled NO for submassive PE

PulmCrit (EMCrit)
PulmCrit - January 28, 2019 - By Josh Farkas

"Summary: The Bullet:
  • The use of an inhaled pulmonary vasodilator is a logical strategy for stabilization of PE patients (especially nitric oxide, which may be depleted in this situation). Previously inhaled nitric oxide has only been supported by case series.
  • iNOPE is a multi-center placebo-controlled RCT which demonstrated that iNO is safe and that it improved hemodynamics (causing improved RV function). The study was too small to determine whether this translated into an improvement in clinical endpoints (e.g. fewer episodes of hemodynamic deterioration).
  • iNOPE utilized a strange composite primary endpoint, which was not different between both groups. For this reason, it may technically be regarded as a “negative” trial.
  • Inhaled nitric oxide may be a very useful therapy to stabilize the crashing PE patient and bridge them to further therapies. Although proving this in an RCT may be nearly impossible, iNOPE provides some evidence to support this therapy."