COVID-19 associated acute respiratory distress syndrome (CARDS) is a severe form of SARS CoV-2 infection and affects about 15–30% of hospitalized patients with a high mortality rate. Growing research and data suggest several available drugs with appropriate pharmacological effects to treat COVID-19. Prostacyclin analogues are regiments for pulmonary artery hypertension. Prostacyclin analogues are expected to be beneficial in treating CARDS based on at least four rationales: (1) inhaled prostacyclin analogues improve oxygenation, V/Q mismatch, and act as an ARDS therapy alternative; (2) it alleviates direct SARS-CoV-2-related coagulopathy; (3) increases nitric oxide production; and (4) possible anti-inflammatory effect. Prostacyclin analogues are available in oral, intravenous, and inhaled forms. The inhaled form has the advantage over other forms, such as parenteral administration risks. Previously, a meta-analysis demonstrated the beneficial effects of inhaled prostaglandins for ARDS treatment, such as improved PaO2/FiO2 and PaO2 along with reduced pulmonary artery pressure. Currently, two ongoing randomized controlled trials are evaluating inhaled epoprostenol (VPCOVID [NCT04452669]) and iloprost (ILOCOVID [NCT04445246]) for severe COVID-19 patients. Inhaled prostacyclin could be considered in patients with refractory, life-threatening hypoxia despite standard management.

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吸入前列环素类似物治疗 COVID-19 相关急性呼吸窘迫综合征：科学原理


COVID-19 相关的急性呼吸窘迫综合征 (CARDS) 是 SARS CoV-2 感染的一种严重形式，影响约 15-30% 的住院患者，死亡率很高。越来越多的研究和数据表明，有几种可用药物具有适当的药理作用来治疗 COVID-19。前列环素类似物是治疗肺动脉高压的药物。基于至少四个理由，预计前列环素类似物可有益于治疗ARDS：（1）吸入前列环素类似物可改善氧合、V/Q 不匹配，并可作为 ARDS 治疗的替代方案； (2) 减轻与 SARS-CoV-2 直接相关的凝血病； (3)增加一氧化氮的产生； (4)可能的抗炎作用。前列环素类似物有口服、静脉注射和吸入形式。吸入形式比其他形式具有优势，例如胃肠外给药的风险。此前，一项荟萃分析证明了吸入前列腺素对 ARDS 治疗的有益作用，例如改善 PaO2/FiO2 和 PaO2 以及降低肺动脉压。目前，两项正在进行的随机对照试验正在评估吸入依前列醇（VPCOVID [NCT04452669]）和伊洛前列素（ILOCOVID [NCT04445246]）对重症 COVID-19 患者的作用。尽管进行了标准治疗，但对于难治性、危及生命的缺氧患者，仍可考虑吸入前列环素。