Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway.

Area of Science:

• Pediatric Critical Care Medicine
• Neonatal Intensive Care
• Cardiology

Background:

• Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator used in critical care.
• Its use is associated with significant costs and potential risks.
• Standardized protocols for iNO initiation and weaning are lacking, leading to variable utilization.

Purpose of the Study:

• To optimize the utilization of inhaled nitric oxide (iNO) in the Cardiac ICU (CICU), Pediatric ICU (PICU), and Neonatal ICU (NICU).
• To establish and evaluate a standard approach for iNO initiation and weaning across different intensive care units.

Main Methods:

• A quality improvement study employing a prospective cohort design with historical controls.
• Implementation of unit-specific standard approaches for iNO initiation and weaning.
• Analysis of iNO utilization data from January 2017 to December 2022 in a quaternary care academic children's hospital.

Main Results:

• A total of 16,087 patients were analyzed across CICU, PICU, and NICU.
• Implementation of the iNO pathway led to a decrease in CICU iNO initiation from 17.8% to 11.8%.
• No significant change in iNO utilization was observed in the PICU or NICU; an estimated 564 days of iNO were saved in the CICU.

Conclusions:

• A standardized pathway for iNO use effectively reduced its utilization in the CICU.
• The impact of the standardized pathway varied across units, with no significant change observed in PICU and NICU.
• Contextual factors within each care setting likely influenced the differential outcomes of the iNO utilization pathway.