The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Inhaled Pulmonary Vasodilators in COVID-19 Infection: 
A Systematic Review and Meta-Analysis 

W. Khokher, MD1*, S. Malhas, MD1, A. Beran, MD1, S. Iftikhar, MD1, C.
Burmeister, MD1, M. Mhanna, MD1, O. Srour, MD1, N. Kesireddy, MD1, R. Assaly,
MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Pulmonary and Critical Care Medicine, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: Waleed.Khokher@utoledo.edu

Published: 05 May 2023 

Introduction: Inhaled pulmonary vasodilators (IPVD) have been previously studied in patients with 
non-coronavirus disease-19 (COVID-19) related acute respiratory distress syndrome (ARDS). The use 
of IPVD have been shown to increase PaO2/FiO2 (P/F) ratios in ARDS patients. However, the role of 
IPVD in COVID-19 ARDS is still unclear. Therefore, we performed this meta-analysis to evaluate the 
role of IPVD in COVID-19 patients.    

Methods: Comprehensive literature search of PubMed, Embase, Web of Science and Cochrane Library 
databases from inception through April 22, 2022 was performed. The single arm studies and case series 
were combined for a 1-arm meta-analysis, and the 2-arm studies were combined for a 2-arm meta-
analysis. Primary outcomes for the 1-arm and 2-arm meta-analyses were change in pre- and post-IPVD 
P/F ratios and mortality, respectively.    

Results: 13 single arm retrospective studies and 5 case series involving 613 patients were included in 
the 1-arm meta-analysis. 3 studies involving 640 patients were included in the 2-arm meta-analysis. The 
pre-IPVD P/F ratios were significantly lower compared to post-IPVD, but there was no significant 
difference between pre- and post-IPVD PEEP and lung compliance. The mortality rates, need for 
endotracheal intubation, and hospital LOS were similar between the IPVD and standard therapy groups.  

Conclusion: Although IPVD may improve oxygenation, our investigation showed no benefits in terms 
of mortality compared to standard therapy alone. However, randomized controlled trials are warranted to 
validate our findings. 

https://dx.doi.org/10.46570/utjms.vol11-2023-705 

https://dx.doi.org/10.46570/utjms.vol11-2023-705
mailto:Waleed.Khokher@utoledo.edu