TY - JOUR
T1 - Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients∗
AU - Yates, Andrew R.
AU - Berger, John T.
AU - Reeder, Ron W.
AU - Banks, Russell
AU - Mourani, Peter M.
AU - Berg, Robert A.
AU - Carcillo, Joseph A.
AU - Carpenter, Todd
AU - Hall, Mark W.
AU - Meert, Kathleen L.
AU - McQuillen, Patrick S.
AU - Pollack, Murray M.
AU - Sapru, Anil
AU - Notterman, Daniel A.
AU - Holubkov, Richard
AU - Dean, J. Michael
AU - Wessel, David L.
N1 - Funding Information:
Drs. Yates’s, Berger’s, Reeder’s, Mourani’s, Hall’s, Meert’s, Pollack’s, Richard’s, Dean’s, and Wessel’s institutions received funding from the National Institutes of Health (NIH). Drs. Yates, Berger, Reeder, Banks, Mourani, Berg, Carcillo, Carpenter, Hall, Meert, McQuillen, Pollack, Sapru, Richard, Dean, and Wessel received support for article research from the NIH. Drs. Yates, Berger, Mourani, Hall, Pollack, and Wessel disclosed the off-label product use of inhaled nitric oxide. Dr. Berger’s institution received funding from Janssen Pharmaceutical and the Association for Pediatric Pulmonary Hypertension. Drs. Banks’s, Berg’s, Carcillo’s, and McQuillen’s institutions received funding from the National Institute of Child Health and Human Development. Dr. Banks disclosed government work. Dr. Hall received funding from La Jolla Pharmaceuticals. Dr. Pollack’s institution received funding from Mallinckrodt Pharmaceuticals. Dr. Richard received funding from Pfizer, the Physicians Committee for Responsible Medicine, and the DURECT Corporation. Dr. Wessel disclosed that he has an endowed chair that was donated to Children’s National Hospital. Dr. Notterman has disclosed that he does not have any potential conflicts of interest.
Funding Information:
Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, and Department of Health and Human Services: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, and U01HD049934.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - 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.
AB - 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.
KW - congenital heart disease
KW - morbidity
KW - nitric oxide
KW - pediatrics
KW - pulmonary hypertension
KW - right ventricular failure
UR - http://www.scopus.com/inward/record.url?scp=85129780034&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000002917
DO - 10.1097/PCC.0000000000002917
M3 - Article
C2 - 35200229
AN - SCOPUS:85129780034
VL - 23
SP - 245
EP - 254
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 4
ER -