Use of inhaled nitric oxide in pediatric cardiac intensive care unit

Abstract

Objective: Experience with administration of inhaled nitric oxide (iNO) in pediatric cardiac intensive care unit was retrospectively reviewed. Methods:Data from 32 pediatric patients treated with iNO between 2011 and 2012 were collected. Patients were divided into 3 groups: Group I comprised postoperative patients, Group II comprised newborns with persistent pulmonary hypertension (PPH), and Group III comprised patients with primary pulmonary hypertension (PH) or Eisenmenger's syndrome. Age, sex, weight, primary diagnosis, arterial blood sample, pulmonary artery pressure (PAP), systemic arterial pressure (SAP), and oxygen saturation levels were analyzed.Results: Groups I, II, and III included 25, 3, and 4 patients, respectively. Median weight was 8 kg (range: 3-40 kg), and median age was 7 months (range: 2 days-10 years). On average, iNO treatment was initiated at the 12th hour after admission to the unit (range: 1-48 hours) and continued for a median duration of 24 hours (range: 12-168 hours). Systolic PAP was 40±15 mmHg, mean SAP was 57±18 mmHg, PAP/SAP ratio was 0.69, and oxygen saturation levels were 88% prior to iNO treatment. Following iNO treatment, PAP decreased to 24±9 mmHg (p<0.05), PAP/SAP ratio decreased to 0.4 (p<0.05), SAP showed no change (60±12 mmHg), and saturation levels increased to 98% (p<0.05). Seven patients died during follow-up (Group I, n=5; Group II, n=1; Group III, n=1).Conclusion: iNO seems to effectively reduce PAP, and can be used effectively and safely to prevent pulmonary hypertensive crises in pediatric cardiac intensive care units. Amaç:Bu çalışmada pediatrik kardiyoloji yoğun bakım ünitesi'nde tedavi amaçlı inhale nitrik oksit (iNO) kullanılan olgular değerlendirildi.Yöntemler: 2011-2012 yılları arasında pediatrik kardiyoloji yoğun bakım ünitesinde iNO kullanılan 32 olgu çalışmaya alındı. Hastalar üç gruba ayrıldı. Grup I (ameliyat sonrası hastalar), Grup II (diretken pulmoner hipertansiyonlu yenidoğan hastalar), Grup III (primer hipertansiyon veya Eisenmenger Sendrom'lu hastalar). Yaş, cinsiyet, ağırlık, primer tanı, kan örneği, pulmoner arter basıncı (PAB), sistemik arteryel basınç (SAB), oksijen satürasyonu değerleri incelendi. Bulgular: Grup I'de 25 olgu, Grup II'de 3 olgu, Grup III'te 4 olgu mevcuttu. Olguların ortanca yaşı 7 ay (dağılım, 2 gün-10 yaş) ve ortanca ağırlığı 8 kg (dağılım, 3-40 kg) idi. iNO ortanca başlama zamanı 12 saat (dağılım, 1-48 saat) ve ortanca kullanım süresi 24 saat (dağılım, 12-168 saat) idi. İNO öncesi ortalama sistolik PAB 40±15 mmHg, ortalama SAB 57±18 mmHg, PAB/SAB=0.69, oksijen satürasyonu %88'idi. Olguların iNO sonrası PAB 24±9 mmHg, SAB 60±12 mmHg, PAB/SAB=0.40, oksijen satürasyonu %98'idi. Pulmoner arter basıncı ve PAB/SAB oranı anlamlı olarak düşerken, satüras-yonda yükselme saptandı (p<0.05). Yedi hasta takip sırasında kaybedildi (Grup I, n=5; Grup II, n=1; Grup III, n=1

Inhaled nitric oxide

“…A number of studies now indicate that inhaled NO has an important role in treating pulmonary hypertension of paediatric and adult patients with respiratory and cardiac failure (Kinsella et al ., 1992; Roberts et al ., 1992; Krasuski et al ., 2000; Cockrill et al ., 2001; Ozturk et al ., 2016). Inhaled NO can also be used during cardiac catheterization to determine the vasodilatory capacity of the pulmonary vascular bed in patients with pulmonary hypertension.…”

A Randomized, Multicenter, Blinded Pilot Study Assessing the Effects of Gaseous Nitric Oxide in an Ex Vivo System of Human Lungs

“…Despite the limitations, the data suggest that the overall health of the lungs treated with NO showed improvement compared with those that received perfusate alone, as seen in the oxygenation and lung weights. This is not surprising, given that endogenous production of NO is decreased during the lung transplant process and that exogenous delivery of NO is known to have vasodilatory, anti-inflammatory, and anti-apoptotic effects in the lung transplant setting [4,[21][22][23][24][25][26]; it was also shown to improve oxygenation and reduce pulmonary artery pressure in patients with impaired oxygenation [32][33][34]. Especially given that NO is a readily available agent, our observations warrant further investigation to determine whether administration of NO would have a clinically meaningful effect following transplantation.…”