Effect of postoperative administration of inhaled nitric oxide combined with high‐frequency oscillatory ventilation in infants with acute hypoxemic respiratory failure and pulmonary hypertension after congenital heart surgery: A retrospective cohort study

Abstract

Objective: To evaluate the effect of inhaled nitric oxide (iNO) combined with highfrequency oscillatory ventilation (HFOV) in the treatment of infants with acute hypoxemic respiratory failure (AHRF) and pulmonary hypertension (PH) after congenital heart surgery.Methods: A retrospective study was conducted on 63 infants with AHRF and PH after congenital heart surgery in our cardiac intensive care unit (CICU) from January 2020 to March 2021. A total of 24 infants in the A group were treated with HFOV combined with iNO, and 39 infants in the B group were treated with HFOV.Relevant clinical data were collected.Results: Comparing the two groups, the improvement of the oxygenation index, PaO 2 and PaO 2 /FiO 2 was more obvious for patients in the A group than for those in the B group after intervention (p < .05). Reexamination on the third day after the initiation of HFOV treatment indicated that the systolic pulmonary artery pressure in the A group was significantly lower than that in the B group (p < .05). In addition, the duration of mechanical ventilation and the length of CICU stay in the A group were shorter than those in the B group (p < .05). However, complications between the two groups were not statistically significant. No important adverse effects arose.Conclusions: For infants with AHRF and PH after congenital heart surgery, iNO combined with HFOV is superior to HFOV alone to improve oxygenation, decrease pulmonary pressure, and shorten the duration of mechanical ventilation and the length of CICU stay, with no adverse effects.

Improving respiratory outcomes after pediatric cardiac surgery: New uses for nitric oxide

“…Huang et al in this issue present a retrospective study of postcardiac surgical pediatric patients with hypoxemic respiratory failure (P/F ratio < 300 or OI > 8) at a single hospital that had failed conventional ventilation. 5 All the children had PHTN confirmed by echocardiography pre-and post-CPB. They had simple left to right shunts (atrial septal defect, VSD, or patent ductus arteriosus) with good surgical repair and acceptable hemodynamic parameters.…”

“…The hospital LOS was not affected, and the complication rate was not significantly different between the groups. 5 Limitations to the general applicability of this study are the fact that it is retrospective, excludes single ventricle physiology, and includes a large fraction (45%) patients who did not undergo CPB. The use of iNO was subject to physician discretion, which introduces the potential for selection bias.…”

“…4 Effective treatment or prevention of prolonged mechanical ventilation in postcardiac surgical infants is beneficial for both the patient and society. The study presented by Huang et al 5 Pagowska-Klimek in 2010 showed a tripling of mean ICU LOS in pediatric cardiac surgical patients with pulmonary hypertension (PHTN). 3 PHTN also increases the risk of prolonged postoperative mechanical ventilation (>7 days) threefold.…”