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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today’s tip is about, “Is nitric oxide an option for my dad in ICU for COVID ARDS?” What a great question to ask.

So, currently, we are working with a client who has their 81-year-old dad in ICU with COVID pneumonia. He’s been there for about one week, for about seven days. He’s in an induced coma. He has been proned on and off. He’s on a 100% of oxygen, FIO2 (Fraction Of Inspired Oxygen) on the ventilator. He’s on a PEEP (Positive End-Expiratory Pressure) of 14 as I mentioned. He has been proned on and off and it seems to be pretty much not working. He also sustained a pneumothorax in the last couple of days. He’s now got a chest tube in situ. The chest X-ray is a complete white out, which suggests there is no gas exchange going on in the lungs. So what are the options from here?

Given that this gentleman is 81–years of age, ECMO unfortunately is not an option. The ECMO cut-off age is usually around 60 to 65. And so the only option that I can see after having worked in intensive care for over 20 years in three different countries, where I also worked as a Nurse Unit Manager for over five years in intensive care, is to start this gentleman on either nitric oxide or on epoprostenol, which I’ve certainly seen work for many ARDS (Acute Respiratory Distress Syndrome) patients in intensive care.

So, when we were talking to the doctors yesterday, they seem to be not knowing about nitric oxide, which I dispute. Nitric oxide is a very common therapy in ICU. One might argue, that it’s a little bit outdated, especially with ECMO coming in, in the last 15 years in intensive care, basically replacing more and more of the nitric oxide therapy. But I’ve also seen patients on ECMO (Extracorporeal Membrane Oxygenation) and on nitric oxide therapy simultaneously.

One might argue, that nitric oxide is very expensive, but it’s certainly a treatment option that needs to be considered especially if all other treatment options are failing. And if the ICU can’t offer nitric oxide or epoprostenol, then the patient clearly needs to be transferred to another hospital where these treatment options are available.

Another factor in this situation, when talking to the doctors yesterday is clearly, that when looking at the arterial blood gas of this gentleman, the PO2 (Partial Pressure Of Oxygen) is 55 and that is very, very low, and very life-threatening. So, they need to act very quickly. Not acting on recommendations, not acting on nitric oxide, not transferring the patient to another hospital, I believe it’s a medical negligence. And the family should push for a transfer to another hospital where these treatment options are available and where they also know about these treatment options because it looks to me like this hospital is either playing dumb or has really not heard of nitric oxide. When you look at the research, if you type into google nitric oxide and ARDS, you will find heaps of research papers and evidence around the effectiveness of nitric oxide with ARDS.

That is my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org, where you have access to me and my team in our membership area and via email where you can ask questions 24-hours a day.

If you need a medical record review while your loved one is in ICU or after ICU, and if you suspect medical negligence in particular, we can help you with that as well.

And, subscribe to my YouTube channel for families in intensive care and for regular updates for Intensive Care Hotline and Intensive Care at Home. Share the video with your friends and families. Share it far and wide. Click the like button, click the notification bell, and comment below what you want to see next, or what questions and insights you have from this video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.