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

TitleCharacterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients.
Publication TypeJournal Article
Year of Publication2022
AuthorsYates, AR, Berger, JT, Reeder, RW, Banks, R, Mourani, PM, Berg, RA, Carcillo, JA, Carpenter, T, Hall, MW, Meert, KL, McQuillen, PS, Pollack, MM, Sapru, A, Notterman, DA, Holubkov, R, J Dean, M, Wessel, DL
Corporate Authors
JournalPediatr Crit Care Med
Volume23
Issue4
Pagination245-254
Date Published2022 04 01
ISSN1529-7535
KeywordsAdministration, Inhalation, Adolescent, Child, Female, Humans, Hypertension, Pulmonary, Infant, Newborn, Meconium Aspiration Syndrome, Nitric Oxide, Ventricular Dysfunction, Right
Abstract

<p><b>OBJECTIVES: </b>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.</p><p><b>DESIGN: </b>Observational cohort study.</p><p><b>SETTING: </b>PICU and cardiac ICUs in seven Collaborative Pediatric Critical Care Research Network hospitals.</p><p><b>PATIENTS: </b>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.</p><p><b>INTERVENTIONS: </b>None.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p>

DOI10.1097/PCC.0000000000002917
Alternate JournalPediatr Crit Care Med
PubMed ID35200229
PubMed Central IDPMC9058189
Grant ListR01 GM108618 / GM / NIGMS NIH HHS / United States
RL1 HD107777 / HD / NICHD NIH HHS / United States
UG1 HD049983 / HD / NICHD NIH HHS / United States
UG1 HD050096 / HD / NICHD NIH HHS / United States
RL1 HD107779 / HD / NICHD NIH HHS / United States
U10 HD049983 / HD / NICHD NIH HHS / United States
UG1 HD063108 / HD / NICHD NIH HHS / United States
RL1 HD107773 / HD / NICHD NIH HHS / United States
UG1 HD083171 / HD / NICHD NIH HHS / United States
U01 HD049934 / HD / NICHD NIH HHS / United States
UG1 HD049981 / HD / NICHD NIH HHS / United States
UG1 HD083170 / HD / NICHD NIH HHS / United States
UG1 HD083166 / HD / NICHD NIH HHS / United States