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

Authors

Andrew R. Yates, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH. Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC. Department of Pediatrics, University of Utah, Salt Lake City, UT. Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA. Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA. Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI. Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA. Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA. Department of Molecular Biology, Princeton University, Princeton, NJ.
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

Document Type

Journal Article

Publication Date

2-23-2022

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

DOI

10.1097/PCC.0000000000002917

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.

APA Citation

Yates, Andrew R.; Berger, John T.; Reeder, Ron W.; Banks, Russell; Mourani, Peter M.; Berg, Robert A.; Carcillo, Joseph A.; Carpenter, Todd; Hall, Mark W.; Meert, Kathleen L.; McQuillen, Patrick S.; Pollack, Murray M.; Sapru, Anil; Notterman, Daniel A.; Holubkov, Richard; Dean, J Michael; and Wessel, David L., "Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients" (2022). GW Authored Works. Paper 121.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/121

Department

Pediatrics