RESUMEN
Background: Coronavirus disease 2019 (COVID-19), a novel respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can progress to critical illness and the development of acute respiratory distress syndrome (ARDS). Variability in clinical presentation has led to 2 distinct theoretical classifications of COVID-19 ARDS based on different phenotypical presentations. The first of which follows closely to traditional ARDS presenting as severe hypoxemia with markedly reduced lung compliance, whereas the second presents as severe hypoxemia with preserved to high lung compliance. With uncertainty surrounding the specific pathological and mechanistic nature of COVID-19, we designed this study to elucidate the potential benefits of inhaled epoprostenol in COVID-19 ARDS. Methods: This was a retrospective, observational, cohort study conducted at a 425-bed teaching hospital. Chart reviews of patients' electronic medical records were conducted and the following data were documented on a password-protected spreadsheet: patient demographics, administration of intravenous fluids and/or corticosteroids, rate and duration of inhaled epoprostenol (0.01-0.05 mcg/kg/min over 7 mL/hr per dose), and ventilator settings while on inhaled epoprostenol, mortality, and intensive care unit (ICU) length of stay (LOS). The primary objective was to evaluate the effect of inhaled epoprostenol on the number of ventilator-free days in COVID-19 patients. Secondary objectives included assessing the effects on ventilator settings, mortality, and ICU LOS. Results: Over the span of 8 months, the charts of 848 patients diagnosed with COVID-19 were reviewed for inclusion in the study. Of those patients, 40 patients (intervention arm) who received at least 1 dose of inhaled epoprostenol (0.01-0.05 mcg/kg/min over 7 mL/hr per dose) were randomly selected for entry into the study. In the control arm, 40 patients with a diagnosis of COVID-19 who did not receive epoprostenol were randomly selected. There were no statistically significant differences in outcomes between the epoprostenol and control arms, in regard to ventilator-free days, ICU LOS, hospital LOS, and in-hospital mortality. Based on maximum ventilator settings during the first 3 days of inhaled epoprostenol use, there were no statistically significant differences between the 2 groups except for an unexpectedly lower oxygen saturation in the epoprostenol group. Conclusion: The use of inhaled epoprostenol did not have a statistically significant effect on ventilator-free days, ventilator settings, hospital and ICU LOS, and overall in-hospital mortality.
RESUMEN
PURPOSE: To evaluate the effectiveness of the Pharmacist-Managed Telephone Tobacco Cessation Clinic (PMTTCC) compared to the standard of care (SOC) at the Veterans Affairs San Diego Healthcare System. METHOD: A retrospective cohort study was performed investigating the proportion of veterans who quit smoking at 6 months while enrolled in the PMTTCC. Chart review was performed using the Veterans Affairs Computerized Patient Record System. The PMTTCC group included patients who had received medication and counseling from the tobacco cessation pharmacists. The cohort was compared to a matched SOC group who did not receive counseling, only tobacco cessation medication therapy through a primary care provider. The primary outcome for this study was patient-reported tobacco cessation at 6 months. Secondary outcomes were abstinence at 1 and 3 months. RESULTS: A total of 1,006 patients were included in the analysis, 503 patients from the PMTTCC and 503 patients from SOC. The overall study population was 54 years old on average, 92.5% male, 70.0% Caucasian, 45.5% with history of psychiatric conditions, and had an average smoking history of 33-pack years. Patients in the PMTTCC group had statistically significant improvements in abstinence at 6 months versus the SOC group (81/503, 16.1% vs. 48/503, 9.5%; p < .0001). Quitters were older on average versus non-quitters (56.03 vs. 53.65 years; p = .01). CONCLUSION: Patients enrolled in the PMTTCC had improved tobacco abstinence rates at 6 months compared to SOC. Although the study was not designed to test for causality, the results lend support for using intensive tobacco cessation management in veteran population.
