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

Andrew R. Yates; 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

doi:10.1097/PCC.0000000000002917

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

Andrew R. Yates, 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

Molecular Biology

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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.

Original language	English (US)
Pages (from-to)	245-254
Number of pages	10
Journal	Pediatric Critical Care Medicine
Volume	23
Issue number	4
DOIs	https://doi.org/10.1097/PCC.0000000000002917
State	Published - Apr 1 2022

All Science Journal Classification (ASJC) codes

Pediatrics, Perinatology, and Child Health
Critical Care and Intensive Care Medicine

Keywords

congenital heart disease
morbidity
nitric oxide
pediatrics
pulmonary hypertension
right ventricular failure

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10.1097/PCC.0000000000002917

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Yates, A. R., Berger, J. T., Reeder, R. W., Banks, R., Mourani, P. M., Berg, R. A., Carcillo, J. A., Carpenter, T., Hall, M. W., Meert, K. L., McQuillen, P. S., Pollack, M. M., Sapru, A., Notterman, D. A., Holubkov, R., Dean, J. M., & Wessel, D. L. (2022). Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients∗. Pediatric Critical Care Medicine, 23(4), 245-254. https://doi.org/10.1097/PCC.0000000000002917

@article{9d3842a290d346edb87fed65ab69d8e9,

title = "Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients∗",

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.",

keywords = "congenital heart disease, morbidity, nitric oxide, pediatrics, pulmonary hypertension, right ventricular failure",

author = "Yates, {Andrew R.} and Berger, {John T.} and Reeder, {Ron W.} and Russell Banks and Mourani, {Peter M.} and Berg, {Robert A.} and Carcillo, {Joseph A.} and Todd Carpenter and Hall, {Mark W.} and Meert, {Kathleen L.} and McQuillen, {Patrick S.} and Pollack, {Murray M.} and Anil Sapru and Notterman, {Daniel A.} and Richard Holubkov and Dean, {J. Michael} and Wessel, {David L.}",

year = "2022",

month = apr,

day = "1",

doi = "10.1097/PCC.0000000000002917",

language = "English (US)",

volume = "23",

pages = "245--254",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

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, Dean, JM & Wessel, DL 2022, 'Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients∗', Pediatric Critical Care Medicine, vol. 23, no. 4, pp. 245-254. https://doi.org/10.1097/PCC.0000000000002917

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.

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

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UR - http://www.scopus.com/inward/citedby.url?scp=85129780034&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000002917

DO - 10.1097/PCC.0000000000002917

M3 - Article

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AN - SCOPUS:85129780034

SN - 1529-7535

VL - 23

SP - 245

EP - 254

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

IS - 4

ER -

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

Abstract

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Keywords

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