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A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
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Postoperative Inhaled Nitric Oxide Does Not Decrease Length of Stay in Pediatric Cardiac Surgery Admissions.

Joshua Wong1, Rohit S Loomba1, Lee Evey2

  • 1Division of Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.

Pediatric Cardiology
|August 26, 2019
PubMed
Summary
This summary is machine-generated.

Inhaled nitric oxide in pediatric cardiac surgery increases hospital stay and costs. It was associated with higher mortality in patients without pulmonary hypertension and did not improve outcomes for those with the condition.

Keywords:
Cardiac surgical proceduresCongenital heart defectsInhaled nitric oxidePediatricsPulmonary hypertension

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Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Cardiovascular Surgery

Background:

  • Pulmonary hypertension is a significant complication following pediatric congenital heart surgery.
  • Inhaled nitric oxide (iNO) is used to treat pulmonary hypertension, but its impact on outcomes after congenital heart surgery requires further characterization.

Purpose of the Study:

  • To analyze the administration of inhaled nitric oxide in pediatric patients undergoing congenital heart surgery.
  • To evaluate the effect of iNO on admission outcomes, including length of stay, costs, and mortality, in children with and without pulmonary hypertension.

Main Methods:

  • A cross-sectional study using data from the Pediatric Health Information System (PHIS) and PHIS+ databases (2004-2015).
  • Inclusion of pediatric patients with congenital heart disease, divided into groups based on pulmonary hypertension status and iNO administration.
  • Statistical analysis included Mann-Whitney-U tests, Fisher's exact tests, univariate, and regression analyses for outcome evaluation.

Main Results:

  • Among 40,194 pediatric cardiac surgical admissions without pulmonary hypertension, 726 (1.8%) received iNO. iNO was linked to increased length of stay, billed charges, and inpatient mortality.
  • Among 1,678 pediatric cardiac surgical admissions with pulmonary hypertension, 195 (11.6%) received iNO. iNO was associated with increased length of stay and billed charges, but not decreased mortality.
  • Regression analyses indicated iNO was independently associated with adverse outcomes in specific patient groups.

Conclusions:

  • Inhaled nitric oxide administration after pediatric cardiac surgery is associated with increased length of stay and healthcare costs.
  • iNO did not demonstrate improved inpatient mortality for children with or without pulmonary hypertension post-cardiac surgery.
  • The use of iNO in this population warrants careful consideration due to increased resource utilization and potential negative impacts on mortality in specific subgroups.