Abstract:

Objective: To evaluate the clinical efficacy and safety of inhaled nitric oxide (iNO) in the treatment of severe and critical novel coronavirus infection by Meta-analysis. Methods: Chinese database (CNKI,Wanfang,Wiper) and English database (PubMed, Embase Web of Science, Cochrane) were searched to retrieve the randomized controlled trials (RCTs) and observational studies about the iNO in the treatment of novel coronavirus infection published from January 2020 to November 2021. The outcomes included oxygenation index (PaO₂/FiO₂), mortality, needs for endotracheal intubation, length of hospital stay, viral load and incidence of complications. The Cochrane manual and Newcastle Ottawa scale (NOS) were used to evaluate the quality of the included studies, and RevMan 5.3 software was used to perform meta-analysis of the literature that met the quality criteria. Results: Fifteen studies were included, including 538 patients, with an average age of 58.5±3.0 years and 67.5% (363/538) male, including 1 RCT study with quality evaluation of “B” and 14 observational studies with NOS score above 5. Meta-analysis showed that oxygenation index was significantly improved after iNO treatment compared with before iNO treatment (SMD=-0.52, 95%CI: -0.73--0.31). There was no significant difference in short-term mortality between the non-iNO treatment group and the iNO treatment group (OR=0.76, 95%CI: 0.17-3.44), and there was no significant difference in mortality between the positive and negative iNO treatment groups (OR=0.66, 95%CI: 0.24-1.80). Conclusion: In patients with novel coronavirus infection, iNO treatment was safe and could improve oxygenation in a short time, but had no effect on short-term mortality.

Key words: Nitric oxide, Coronavirus infections, Severe acute respiratory syndrome, Meta-analysis