Keeping This Complex COVID-19 Patient Off the Vent —A Case Story of Inhaled Epoprostenol, High Velocity Therapy, and Healthcare Team Perseverance

Although individual results may vary, Vapotherm believes this case story is an example of the clinical benefit Vapotherm’s high velocity therapy can have in an ICU setting.

About six months into the COVID-19 pandemic, 61-year-old Ethan* was admitted to the ICU with complications from COVID-19 and comorbidities including stage III chronic kidney disease.

Since the outbreak, the medical community has made remarkable strides in improving treatment protocols and reducing mortality rates across the globe, [1] but fatalities are still not rare. Earlier in the year, Ethan lost an uncle who had been put on mechanical ventilation for COVID-19. Now a patient himself in deteriorating condition (see Table 1), Ethan was apprehensive about intubation, and asked about care options to avoid it.

Table 1: COVID ICU Patient Vital Sign Data

DayRespiratory Rate
(breaths per minute)
SpO2Vapotherm High
Velocity Settings
04483% (on a NRB at flush)N/A
Vapotherm High Velocity Therapy Initiated
1-228-3688-93%40 L/min, 60% FiO2
34484%40 L/min, 100% FiO2

After interventions to increase Ethan’s SpO2 showed only mild improvement, the medical team decided on an alternative to mechanical ventilation. They administered inhaled Epoprostenol concurrently with the Vapotherm high velocity aerosol disposable patient circuit. His RR decreased to 28 and SpO2 increased to 95% over 10 minutes.

Ethan remained on the highest high velocity therapy settings while receiving inhaled Epoprostenol for 3 days. During this time, his respiratory rate ranged from 24 – 32 bpm and his SpO2 91-97%. After those three days, the Epoprostenol was slowly weaned to discontinuation. Ethan remained on high velocity therapy for another 18 days, with an SpO2 target of 88-95%, before he was transitioned to a low flow nasal cannula. (See Table 2)

Table 2: Continued COVID ICU Vital Sign Data with Introduction of Inhaled Epoprostenol

Day SpO2Vapotherm High
Velocity Settings
Inhaled Epoprostenol concurrently with
High Velocity Aerosol Circuit
3-691-97%40 L/min, 100% FiO230,000 ng/mL
7-8not available40 L/min, 100% FiO220,000 ng/mL, then decreased by half every 8 hours until a dose of 2,500 ng/mL
8-2688-95%Titrated to target 88-95% SpO2discontinued

After the COVID ICU, Ethan stayed in the hospital’s COVID ward for another 9 days. His hospitalization entailed several other health complications, but he was not intubated. When he was reached about four weeks after discharge, Ethan said he was still experiencing “brain fog” among other problems, but he also expressed immense gratitude for the care he had received.

The attending physician believes that innumerable factors contributed to Ethan’s favorable outcome, but that  high velocity therapy concurrent with administration of inhaled Epoprostenol prevented the need for invasive ventilation.

*Names have been changed to protect patient privacy

[1] Armstrong RA, Kane AD, Cook TM. “Outcomes from intensive care in patients with COVID‐19: a systematic review and meta‐analysis of observational studies.” Anaesthesia. June 2020. Anaesthesia 2020 doi:10.1111/anae.15201​