The Use of Inhaled Nitric Oxide After Pediatric Cardiac Surgery

Inhaled nitric oxide (iNO) lowers pulmonary vascular resistance and improves pulmonary gas exchange. It has become a common therapy following pediatric cardiac surgery, but there are limited data on its current use or clinical impact in this population. This retrospective analysis reviewed all patients within the Pediatric Cardiac Critical Care Consortium (PC⁴) clinical registry, representing 63 North American cardiac intensive care units (CICU), who underwent cardiac surgery from August 2014 to August 2023, to describe contemporary iNO use and its relationship to patient characteristics and outcomes. We also investigated the relationship between timing of iNO therapy for postoperative pulmonary hypertension (PH) and mortality. Of 63,582 non-neonatal patients admitted to the CICU following cardiac surgery, 12.2% received iNO, with 34.8% of those receiving it for PH. Of 17,792 neonates who underwent cardiac surgery, 26.6% received iNO, with 29.3% of those receiving it for PH. Single ventricle surgeries and heart transplant were the most common operations associated with iNO use. iNO use has increased over time, and utilization varies widely across centers, ranging from 0% to 65% of neonates, and 4% to 47% of infants. In a multivariable logistic regression model of patients who received iNO postoperatively for PH, initiation of therapy during the CICU stay, as compared to at CICU admission, was associated with increased mortality (odds ratio 1.54). Using contemporary multicenter registry data, we identify patient and operative characteristics associated with iNO use. Variations by center and by timing suggest opportunities to optimize use of the therapy.