Cabrera M, Bharil S, Chin M, Yohannes S, Clark P. Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome. World J Crit Care Med 2025; 14(3): 101327 [DOI: 10.5492/wjccm.v14.i3.101327]
Corresponding Author of This Article
Matthew Cabrera, MD, Researcher, Department of Critical Care Medicine, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, United States. mpc125@georgetown.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2025; 14(3): 101327 Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.101327
Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome
Matthew Cabrera, Sarika Bharil, Meghan Chin, Seife Yohannes, Paul Clark
Matthew Cabrera, Sarika Bharil, Meghan Chin, Department of Critical Care Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
Seife Yohannes, Paul Clark, Department of Critical Care, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Cabrera M wrote the original draft; Cabrera M, Bharil S and Chin M designed the study, were responsible for developing the methodology and participated in the formal analysis and investigation; Cabrera M, Bharil S, Chin M, Yohannes S, and Clark P participated in the review and editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was approved by the Georgetown University-Medstar Health Institutional Review Board (No. STUDY00002769). It was determined exempt due to the low risk of harm of this research to its participants.
Informed consent statement: Signed informed consent was exempt by our Institutional Review Board given the data collected was retrospective chart review and all patients were de-identified during data collection.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matthew Cabrera, MD, Researcher, Department of Critical Care Medicine, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, United States. mpc125@georgetown.edu
Received: September 10, 2024 Revised: February 3, 2025 Accepted: February 25, 2025 Published online: September 9, 2025 Processing time: 310 Days and 15.7 Hours
Core Tip
Core Tip: In this retrospective study at two tertiary academic medical centers during the initial coronavirus disease 2019 surge, we examine trends in ventilator mechanics and outcomes of 114 acute respiratory distress syndrome (ARDS) patients receiving three adjunct therapies (prone positioning, neuromuscular blockade and inhaled vasodilations). We found a significant improvement in arterial oxygen partial pressure/fractional inspired oxygen ratio with the addition of inhaled vasodilators while proning and in lung compliance with the addition of continuous neuromuscular blockade among others. Our groups were not large enough to detect a difference in mortality or length of stay. However, this study provides a large amount of data and multi-day trends to further our understanding of the physiologic response to multiple adjunct therapies for ARDS in combination.
