Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients.

Abstract

OBJECTIVES:

Characterize the use of inhaled nitric oxide (iNO) for pediatric cardiac patients and assess the relationship between patient characteristics before iNO initiation and outcomes following cardiac surgery.

DESIGN:

Observational cohort study.

SETTING:

PICU and cardiac ICUs in seven Collaborative Pediatric Critical Care Research Network hospitals.

PATIENTS:

Consecutive patients, less than 18 years old, mechanically ventilated before or within 24 hours of iNO initiation. iNO was started for a cardiac indication and excluded newborns with congenital diaphragmatic hernia, meconium aspiration syndrome, and persistent pulmonary hypertension, or when iNO started at an outside institution.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Four-hundred seven patients with iNO initiation based on cardiac dysfunction. Cardiac dysfunction patients were administered iNO for a median of 4 days (2-7 d). There was significant morbidity with 51 of 407 (13%) requiring extracorporeal membrane oxygenation and 27 of 407 (7%) requiring renal replacement therapy after iNO initiation, and a 28-day mortality of 46 of 407 (11%). Of the 366 (90%) survivors, 64 of 366 patients (17%) had new morbidity as assessed by Functional Status Scale. Among the postoperative cardiac surgical group (n = 301), 37 of 301 (12%) had a superior cavopulmonary connection and nine of 301 (3%) had a Fontan procedure. Based on echocardiographic variables prior to iNO (n = 160) in the postoperative surgical group, right ventricle dysfunction was associated with 28-day and hospital mortalities (both, p < 0.001) and ventilator-free days (p = 0.003); tricuspid valve regurgitation was only associated with ventilator-free days (p < 0.001), whereas pulmonary hypertension was not associated with mortality or ventilator-free days.

CONCLUSIONS:

Pediatric patients in whom iNO was initiated for a cardiac indication had a high mortality rate and significant morbidity. Right ventricular dysfunction, but not the presence of pulmonary hypertension on echocardiogram, was associated with ventilator-free days and mortality.

• Authors: Andrew R Yates, John T Berger, Ron W Reeder, Russell Banks, Peter M Mourani, Robert A Berg, Joseph A Carcillo, Todd Carpenter, Mark W Hall, Kathleen L Meert, Patrick S McQuillen, Murray M Pollack, Anil Sapru, Daniel A Notterman, Richard Holubkov, J Michael Dean, David L Wessel, on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 23 Issue 4 Pg. 245-254 (04 01 2022) ISSN: 1529-7535 [Print] United States
• PMID: 35200229 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Chemical References

• Nitric Oxide

Topics

• Administration, Inhalation
• Adolescent
• Child
• Female
• Humans
• Hypertension, Pulmonary (drug therapy)
• Infant, Newborn
• Meconium Aspiration Syndrome
• Nitric Oxide (therapeutic use)
• Ventricular Dysfunction, Right (drug therapy)