Post-Extubation Inhaled Nitric Oxide Therapy via High-Flow Nasal Cannula After Fontan Procedure

Area of Science:

• Cardiology
• Pediatric Cardiology
• Critical Care Medicine

Background:

• The Fontan procedure is a complex surgery for single-ventricle congenital heart defects.
• Postoperative management of hemodynamically unstable patients after Fontan procedure requires optimized respiratory support.
• Inhaled nitric oxide (iNO) is used to improve pulmonary hemodynamics, but its efficacy can be enhanced with delivery methods like high-flow nasal cannula (HFNC).

Purpose of the Study:

• To evaluate the impact of adding HFNC to iNO therapy (HFNC-iNO) in patients extubated after Fontan procedure.
• To compare outcomes between patients receiving iNO alone versus those receiving HFNC-iNO therapy post-extubation.

Main Methods:

• Retrospective review of 38 patients undergoing Fontan procedure between January 2010 and June 2016.
• Patients were divided into two groups: Epoch 1 (n=24) received iNO therapy, and Epoch 2 (n=14) received iNO therapy plus HFNC-iNO post-extubation.
• Comparison of postoperative outcomes including intubation duration, pleural drainage, hospitalization length, and re-intubation rates.

Main Results:

• The HFNC-iNO group (Epoch 2) showed significantly shorter durations of postoperative intubation (3.5 vs. 7.2 hours), pleural drainage (9.5 vs. 23 days), and hospitalization (27 vs. 36 days).
• No patients in the HFNC-iNO group required re-intubation, compared to 8.3% in the iNO-only group.
• No significant differences were observed in preoperative characteristics or intensive care unit admission parameters between the groups.

Conclusions:

• The addition of HFNC to iNO therapy (HFNC-iNO) significantly improves postoperative recovery in patients after Fontan procedure.
• HFNC-iNO therapy is associated with reduced mechanical ventilation duration, pleural effusion, and overall hospital stay.
• This combined therapy represents a beneficial advancement in the management of unstable hemodynamics post-Fontan procedure.