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Implementation of an Inhaled Nitric Oxide Weaning Protocol and Stewardship in a Level 4 NICU to Decrease

Walid A Hussain1, Deborah S Bondi2, Pooja Shah2

  • 1Section of Neonatology, Department of Pediatrics (WAH), Loyola University Medical Center, Maywood, IL.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|March 30, 2022
PubMed
Summary
This summary is machine-generated.

Implementing a multidisciplinary inhaled nitric oxide (iNO) weaning protocol in the NICU significantly reduced iNO use by 60% without adverse effects. This protocol optimizes treatment for neonatal pulmonary hypertension.

Keywords:
inhaled nitric oxideneonatalstewardshipweaning protocol

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Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Pharmacology

Background:

  • Inhaled nitric oxide (iNO) is a vital treatment for neonatal pulmonary hypertension.
  • High costs and limited data on weaning protocols necessitate optimized iNO use.
  • Institutional stewardship is crucial for managing expensive therapies like iNO.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary iNO weaning protocol on iNO usage in a neonatal intensive care unit (NICU).
  • To assess the effectiveness and safety of a new protocol for weaning iNO in neonates.
  • To reduce inappropriate utilization of inhaled nitric oxide.

Main Methods:

  • A single-center study comparing pre-protocol (retrospective) and post-protocol (prospective) cohorts.
  • Inclusion of all neonates receiving iNO in the NICU during the study period.
  • Primary outcome measured was the duration of iNO administration per treatment course.

Main Results:

  • iNO courses decreased from 47 to 37 post-protocol implementation.
  • Median iNO duration per course significantly reduced from 149 to 59 hours (p=0.008).
  • Successful weaning rates were 74% with 72% compliance to protocol initiation.

Conclusions:

  • Implementation of an iNO weaning protocol led to a ~60% reduction in iNO usage.
  • The protocol demonstrated significant cost-saving potential without adverse clinical outcomes.
  • Optimized iNO weaning protocols are effective in neonatal care settings.