Title | Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients. |
Publication Type | Journal Article |
Year of Publication | 2022 |
Authors | Yates, 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 | |
Journal | Pediatr Crit Care Med |
Volume | 23 |
Issue | 4 |
Pagination | 245-254 |
Date Published | 2022 Apr 01 |
ISSN | 1529-7535 |
Keywords | Administration, 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> |
DOI | 10.1097/PCC.0000000000002917 |
Alternate Journal | Pediatr Crit Care Med |
PubMed ID | 35200229 |
PubMed Central ID | PMC9058189 |
Grant List | R01 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 |