Almitrine for COVID-19 critically ill patients – a vascular therapy for a pulmonary vascular disease: Three case reports

Table 1 Patients’ characteristics prior and after almitrine infusion

Variables	Case 1	Case 2	Case 3
Age in yr	57	56	53
BMI in kg/m2	38.9	39.0	40.1
Gender	Female	Female	Male
Medical history	Smoking, hypertension, obesity	Dyslipidemia, obesity	Rheumatoid arthritis, obesity
Medication use	None	Statin	Steroids
Days from symptom onset to hospital admission in d	7	11	5
Days from hospital admission to ICU admission in d	2	6	6
High flow or low flow oxygen support prior to mechanical ventilation in d	2	5	5
Mechanical ventilation prior to almitrine infusion in d	2	1	2
Chest CT scan	GGO, crazy paving and severe lobar involvement (> 75%), no pulmonary embolism	GGO, crazy paving and moderate lobar involvement (50%-75%), no pulmonary embolism	GGO, bilateral crazy paving, consolidation, limited lobar involvement (25%), no pulmonary embolism
Respiratory management	Two sessions	No	Two sessions
Prone positioning before almitrine infusion/Position during almitrine infusion	Supine	Supine	Supine
Hemodynamic parameters ICU admission
HR as /min	66	115	61
SAP in mmHg/DAP in mmHg MAP in mmHg	115/50 (71)	119/69 (85)	124/61 (82)
SpO2, %	90	90
Lactate in mmol/L	1.800	1.900	1.493
Norepinephrine infusion as μg × kg × min-1	0.09	-	0.35
SAPS II	68	40	56
SOFA	13	7	8
Respiratory parameters
Baseline
PaO2/FiO2	77	91	95
PEEP in cmH2O	14	14	15
Plateau pressure in cmH2O	28	27	29
Compliance in mL/cmH2O	32	33	31
H1
PaO2/FiO2	82	150	121
PEEP in cmH2O	14	14	15
Plateau pressure in cmH2O	30	29	28
Compliance in mL/cmH2O	29	28	33
H2
PaO2/FiO2	163	330	135
PEEP in cmH2O	14	14	15
Plateau pressure in cmH2O	30	29	28
Compliance in mL/cmH2O	28	29	33
H12
PaO2/FiO2	233	160	214
PEEP in cmH2O	14	14	15
Plateau pressure in cmH2O	30	27	28
Compliance in mL/cmH2O	27	32	34
Pulmonary artery catheter
Baseline
Mean PAP in mmHg	42	32	34
Systolic PAP in mmHg	57	42	44
PAOP in mmHg	7	9	11
CI in L/min/m2	2.6	2.9	2.9
PVR in Wood Units	5.9	4.1	3.3
H1
Mean PAP in mmHg	42	30	35
Systolic PAP in mmHg	65	39	41
PAOP in mmHg	8	9	13
CI in L/min/m2	2.6	2.9	2.6
PVR in Wood Units	5.9	4.2	3.5
H2
Mean PAP in mmHg	37	30	39
Systolic PAP in mmHg	52	33	45
PAOP in mmHg	8	11	14
CI in L/min/m2	3.9	3.1	2.6
PVR in Wood Units	3.4	3.2	3.9
H12
Mean PAP in mmHg	36	29	35
Systolic PAP in mmHg	50	49	40
PAOP in mmHg	6	11	10
CI in L/min/m2	3.0	2.6	2.5
PVR in Wood Units	4.5	3.6	4.2
TEE-Right ventricular parameters
Baseline
RV FAC, %	45	42	58
RV outflow tract VTI in cm	19	13	19
H2
RV FAC, %	44	42	34
RV outflow tract VTI in cm	16	15	24
H12
RV FAC, %	48	34	42
RV outflow tract VTI in cm	15	16	19
TEE 2D-STE parameters
Baseline
RVGLS, %	13.5	25.3	14.8
TMAD septal in mm	13.0	29.7	23.5
H2
RVGLS, %	13.3	24.7	22.7
TMAD septal in mm	9.6	27.6	25.0
H12
RVGLS, %	16.9	25.0	18.7
TMAD septal in mm	16	32	23
ICU course
Length of stay in d	30	32	31
Mechanical ventilation duration in d	18	22	21
Outcomes	Discharged from ICU	Discharged from ICU	Discharged from ICU

BMI: Body mass index; CI: Cardiac index; CT: Computed tomography; DAP: Diastolic arterial pressure; FAC: Fractional area change; GGO: Ground-glass opacity; H1: 1 h after almitrine infusion; H2: 2 h after almitrine infusion; H12: 12 h after almitrine infusion; HR: Heart rate; ICU: Intensive care unit; MAP: Mean arterial pressure; NO: Nitric oxide; PAP: Pulmonary artery pressure; PAOP: Pulmonary artery occlusion pressure; PBW: Predicted body weight; PEEP: Positive end-expiratory pressure; PVR: Pulmonary vascular resistance; RV: Right ventricle; RVGLS: Right ventricle global longitudinal strain; SAP: Systolic arterial pressure; SAPS II: Simplified acute physiology score; SOFA: Sepsis-related Organ Failure Assessment; STE: Speckle tracking echocardiography; TEE: Transesophageal echocardiography; TMAD: Tricuspid longitudinal annular displacement; VTI: Velocity time integral.

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