Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3385-3393
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3385
Almitrine for COVID-19 critically ill patients – a vascular therapy for a pulmonary vascular disease: Three case reports
Pierre Huette, Osama Abou Arab, Vincent Jounieaux, Mathieu Guilbart, Mohamed Belhout, Guillaume Haye, Hervé Dupont, Christophe Beyls, Yazine Mahjoub
Pierre Huette, Osama Abou Arab, Mathieu Guilbart, Guillaume Haye, Hervé Dupont, Christophe Beyls, Yazine Mahjoub, Department of Anaesthesia and Critical Care, Amiens Hospital University, Amiens 80000, France
Vincent Jounieaux, Department of Respiratory Medicine, Amiens Hospital University, Amiens 80000, France
Mohamed Belhout, Department of Pharmacy, Amiens Hospital University, Amiens 80000, France
Author contributions: Huette P, Abou Arab O, Beyls C and Mahjoub Y conceived the study and drafted the manuscript; Jounieaux V, Guilbart M, Belhout M, Haye G and Dupont H participated in data acquisition and helped to draft the manuscript.
Informed consent statement: Local institutional review board waived the need for written informed consent; data storage was authorized by national licensing authority (CNIL PI2020_843_0026). Patients and/or next of kin were informed of the study.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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:
Corresponding author: Pierre Huette, MD, Doctor, Department of Anaesthesia and Critical Care, Amiens Hospital University, Avenue Rene-Laennec, Amiens 80000, France.
Received: November 17, 2020
Peer-review started: November 17, 2020
First decision: December 28, 2020
Revised: December 31, 2020
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: May 16, 2021

Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus disease 2019 (COVID-19) patients. It has been hypothesized that an increased pulmonary blood flow associated with an impairment of hypoxic pulmonary vasoconstriction is responsible for an intrapulmonary shunt. COVID-19 may lead to refractory hypoxemia (PaO2/FiO2 ratio below 100 mmHg) despite mechanical ventilation and prone positioning. We hypothesized that the use of a pulmonary vasoconstrictor may help decrease the shunt and thus enhance oxygenation.


We report our experience with three patients with refractory hypoxemia treated with almitrine to enhance oxygenation. Low dose almitrine (Vectarion®; Servier, Suresnes, France) was started at an infusion rate of 4 μg × kg/min on a central line. The PaO2/FiO2 ratio and total respiratory system compliance during almitrine infusion were measured. For the three patients, the PaO2/FiO2 ratio time-course showed a dramatic increase whereas total respiratory system compliance was unchanged. The three patients were discharged from the intensive care unit. The intensive care unit length of stay for patient 1, patient 2 and patient 3 was 30 d, 32 d and 31 d, respectively. Weaning from mechanical ventilation was performed 13 d, 18 d and 15 d after almitrine infusion for patient 1, 2 and 3, respectively. We found no deleterious effects on the right ventricular function, which was similar to previous studies on almitrine safety.


Almitrine may be effective and safe to enhance oxygenation in coronavirus disease 2019 patients. Further controlled studies are required.

Keywords: COVID-19, Treatment, Acute vascular distress syndrome, Almitrine, Intensive care unit, Safety, Case report

Core Tip: It has been hypothesized that increased pulmonary blood flow associated with impaired hypoxic vasoconstriction may lead to significant intrapulmonary shunt that plays a major role in coronavirus disease 2019 related severe hypoxia. In this report, three coronavirus disease 2019 patients with refractory hypoxemia were treated with continuous infusion of almitrine, a specific pulmonary vasoconstrictor. Almitrine infusion enhanced oxygenation of patients with severe coronavirus disease 2019 related acute respiratory distress syndrome without any change in pulmonary artery pressures and right ventricular function.