Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Metzger, Jay


COVID-19, pulmonary vasodilators, nitric oxide, epoprostenol, iloprost, and prone positioning


The purpose of this research and literature review is to compare the use of prone positioning and respiratory pharmacotherapeutics within hospitalized COVID-19 patients and the outcomes associated with each. A literature review was performed using the databases PubMed, Clinical Key, DynaMed, and CINAHL. A variety of key terms were used when searching. Studies chosen were retrospective reviews, a cross sectional study, an interventional study, and a pilot study. Articles within the last three years were utilized after exclusion criteria was applied. A total of thirteen articles were included within this project. The research shows that pulmonary vasodilators such as inhaled nitric oxide (iNO), epoprostenol (iEpo), and Iloprost did improve oxygenation within COVID-19 patients. Nitric oxide was seen to have the greatest impacts but is not a first line choice due to cost and potential adverse effects. The PF ratio is defined by a patient’s oxygen in the arterial blood (PaO2) to the fraction of oxygen in the inspired air (FiO2) and was used as a marker for treatment and severity of disease throughout the literature. The research also showed the addition of prone positioning to the use of pulmonary vasodilators increased oxygenation and subsequently increased the PF ratios of the patients. iNO with prone positioning was seen to have the largest increase in PF ratios throughout the studies. Prone positioning was associated most with an adverse effect of pressure ulcers, with most being on the head and face. The most common adverse effect with the use of iEpo was noted to be bleeding which was not life threatening. iNO was noted to have bleeding and methemoglobinemia as the most common adverse effects. Overall, further research needs to be performed with larger patient populations and more control over various factors that could influence the patient’s prognosis.