Pediatr Crit Care Med
. 2022 Feb 23. doi: 10.1097/PCC.0000000000002917. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35200229/
Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients
Andrew R Yates 1, 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, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research NetworkAffiliations expand
- PMID: 35200229
- DOI: 10.1097/PCC.0000000000002917
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.
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.
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