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Published on: May 4, 2021

Inhaled Nitric Oxide via High-Flow Nasal Cannula in Postrepair Congenital Heart Disease Patients With Pulmonary

Xiaofeng Wang1, Qinnan Chen1, Shilin Wang2

  • 1Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

World Journal for Pediatric & Congenital Heart Surgery
|June 25, 2026
PubMed

Insights

Continuing inhaled nitric oxide (iNO) via high-flow nasal cannula (HFNC) after surgery for pediatric congenital heart disease (CHD) offers a faster recovery. This fast-weaning strategy is safe and effective for managing pulmonary arterial hypertension (PAH).

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Pulmonary Hypertension Management

Background:

  • Congenital heart disease (CHD) repair in pediatric patients with pulmonary arterial hypertension (PAH) risks pulmonary hypertensive crisis (PHC).
  • Conventional treatment involves inhaled nitric oxide (iNO) post-surgery, often leading to prolonged recovery.
  • A novel fast-weaning strategy using iNO via high-flow nasal cannula (HFNC) is proposed to improve outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of a fast-weaning strategy for iNO delivery in pediatric CHD patients with PAH.
  • To compare recovery times between fast-weaning (iNO via HFNC) and standard-weaning protocols.
  • To assess the incidence of PHC recurrence with the proposed fast-weaning approach.

Main Methods:

  • Single-center, retrospective cohort study of pediatric patients with CHD and elevated pulmonary vascular resistance index (PVRi).
  • Patients were divided into a fast-weaning group (iNO via HFNC post-extubation, 2023-2024) and a standard-weaning group (conventional iNO tapering, 2019-2022).
  • Propensity-score matching was used, considering age, preoperative PVRi, and cardiopulmonary bypass duration.

Main Results:

  • Twenty-two matched pairs were analyzed; PHC recurrence was similar between groups (9.1% vs. 13.6%, p > 0.99).
  • The fast-weaning group showed significantly shorter mechanical ventilation duration (18 vs. 21.5 hours, p = 0.014).
  • Postoperative ICU length of stay was also significantly reduced in the fast-weaning group (2 vs. 3 days, p = 0.023).

Conclusions:

  • Continuing iNO via HFNC post-extubation is a safe and effective fast-weaning strategy for pediatric CHD patients with PAH.
  • This approach is associated with accelerated recovery, including reduced mechanical ventilation and ICU stay.
  • It presents a promising alternative to conventional iNO weaning protocols, potentially optimizing postoperative care.
Abstract

Keywords:
congenital heart diseasehigh-flow nasal cannulainhaled nitric oxidepulmonary arterial hypertensionsystemic to pulmonary shunt

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