Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T08:15:02.669Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of inhaled nitric oxide on haemodynamics and gas exchange in children after having undergone cardiac surgery utilising cardiopulmonary bypass

Published online by Cambridge University Press:  23 June 2020

Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Salvatore Aiello ,
Lee W. Evey ,
Saul Flores  and
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]
Enrique G. Villarreal*
Affiliation:
Texas Children’s Hospital/Baylor School of Medicine, Houston, TX, USA Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Salvatore Aiello
Affiliation:
Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
Lee W. Evey
Affiliation:
Texas Children’s Hospital/Baylor School of Medicine, Houston, TX, USA
Saul Flores
Affiliation:
Texas Children’s Hospital/Baylor School of Medicine, Houston, TX, USA
Rohit S. Loomba
Affiliation:
Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA Advocate Children’s Hospital, Oak Lawn, IL, USA
*
Author for correspondence: Enrique G. Villarreal, MD, Research Scholar, Cardiac Intensive Care Unit, Section of Critical Care and Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 S. Main St, MCE 1420, Suite E.1460.31A, Houston, TX, USA. Tel: +1 (312) 282-6935; Fax: +1 (832) 825-2969. E-mail: quique_villarreal93@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

For CHD patients undergoing corrective surgery utilising cardiopulmonary bypass, post-operative inhaled nitric oxide has been administered to alleviate pulmonary hypertension. We performed a systematic review and meta-analyses to determine the effect of inhaled nitric oxide on haemodynamics, gas exchange, and hospitalisation characteristics in children immediately after cardiopulmonary bypass.

Materials and methods:

A systematic review of the literature was performed to identify full-text manuscripts in English. PubMed, EMBASE, and the Cochrane databases were queried. Once manuscripts were identified for inclusion, a list of all the endpoints in each manuscript was created. Endpoints with data present from two or more studies were then kept for pooled analyses. All endpoints included were continuous variables and so mean and standard deviation were utilised as the effect data for comparison.

Results:

A total of eight studies were deemed appropriate for inclusion. There were significant differences with decreases in mean pulmonary artery pressure of −6.82 mmHg, left atrial pressure of −1.16 mmHg, arteriovenous oxygen difference of −1.63, arterial carbon dioxide concentration of −2.41 mmHg, mechanical ventilation duration of −8.56 hours, and length of cardiac ICU stay duration of −0.91 days. All significant variables achieved p < 0.001.

Conclusion:

Inhaled nitric oxide in children immediately after cardiopulmonary bypass decreases mean pulmonary artery pressure significantly and decreases the arterial carbon dioxide concentration significantly without significantly altering other haemodynamic parameters. This results in a statistically shorter duration of mechanical ventilation and cardiac ICU length of stay without altering overall hospital length of stay.

Keywords

Nitric oxidechildcardiac surgical proceduresCHDsartificial respirationpulmonary hypertension
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 8 , August 2020 , pp. 1151 - 1156
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bando, K, Turrentine, MW, Sharp, TG, et al.Pulmonary hypertension after operations for congenital heart disease: analysis of risk factors and management. J Thorac Cardiovasc Surg 1996; 112: 1600–1607; discussion 1607–1609.CrossRefGoogle ScholarPubMed
Adatia, I, Atz, AM, Jonas, RA, Wessel, DL.Diagnostic use of inhaled nitric oxide after neonatal cardiac operations. J Thorac Cardiovasc Surg 1996; 112: 1403–1405.CrossRefGoogle ScholarPubMed
Curran, RD, Mavroudis, C, Backer, CL, Sautel, M, Zales, VR, Wessel, DL.Inhaled nitric oxide for children with congenital heart disease and pulmonary hypertension. Ann Thorac Surg 1995; 60: 1765–1771.CrossRefGoogle ScholarPubMed
Atz, AM, Wessel, DL.Inhaled nitric oxide in the neonate with cardiac disease. Semin Perinatol 1997; 21: 441–455.CrossRefGoogle ScholarPubMed
Wessel, DL, Adatia, I, Giglia, TM, Thompson, JE, Kulik, TJ.Use of inhaled nitric oxide and acetylcholine in the evaluation of pulmonary hypertension and endothelial function after cardiopulmonary bypass. Circulation 1993; 88: 2128–2138.CrossRefGoogle ScholarPubMed
Beghetti, M, Silkoff, PE, Caramori, M, Holtby, HM, Slutsky, AS, Adatia, I.Decreased exhaled nitric oxide may be a marker of cardiopulmonary bypass-induced injury. Ann Thorac Surg 1998; 66: 532–534.CrossRefGoogle ScholarPubMed
Mathru, M, Huda, R, Solanki, DR, Hays, S, Lang, JD.Inhaled nitric oxide attenuates reperfusion inflammatory responses in humans. Anesthesiology 2007; 106: 275–282.CrossRefGoogle ScholarPubMed
Shah, S, Szmuszkovicz, JR.Pediatric perioperative pulmonary arterial hypertension: a case-based primer. Children (Basel) 2017; 4: 92.Google ScholarPubMed
Barr, FE, Macrae, D.Inhaled nitric oxide and related therapies. Pediatr Crit Care Med 2010; 11: S30–36.10.1097/PCC.0b013e3181c76b42CrossRefGoogle ScholarPubMed
Bizzarro, M, Gross, I, Barbosa, FT.Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. Cochrane Database Syst Rev 2014: CD005055.Google ScholarPubMed
Beghetti, M, Habre, W, Friedli, B, Berner, M.Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients. Br Heart J 1995; 73: 65.CrossRefGoogle ScholarPubMed
Morris, K, Beghetti, M, Petros, A, Adatia, I, Bohn, D.Comparison of hyperventilation and inhaled nitric oxide for pulmonary hypertension after repair of congenital heart disease. Crit Care Med 2000; 28: 2974–2978.CrossRefGoogle ScholarPubMed
Day, RW, Hawkins, JA, McGough, EC, Crezee, KL, Orsmond, GS.Randomized controlled study of inhaled nitric oxide after operation for congenital heart disease. Ann Thorac Surg 2000; 69: 1907–1912; discussion 1913.CrossRefGoogle ScholarPubMed
Shimpo, H, Mitani, Y, Tanaka, J, et al.Inhaled low-dose nitric oxide for postoperative care in patients with congenital heart defects. Artif Organs 1997; 21: 10–13.CrossRefGoogle ScholarPubMed
Checchia, PA, Bronicki, RA, Muenzer, JT, et al.Nitric oxide delivery during cardiopulmonary bypass reduces postoperative morbidity in children – a randomized trial. J Thorac Cardiovasc Surg 2013; 146: 530–536.CrossRefGoogle ScholarPubMed
James, C, Millar, J, Horton, S, Brizard, C, Molesworth, C, Butt, W.Nitric oxide administration during paediatric cardiopulmonary bypass: a randomised controlled trial. Intensive Care Med 2016; 42: 1744–1752.CrossRefGoogle ScholarPubMed
Checchia, PA, Bronicki, RA, Goldstein, B.Review of inhaled nitric oxide in the pediatric cardiac surgery setting. Pediatr Cardiol 2012; 33: 493–505.CrossRefGoogle ScholarPubMed
Fullerton, DA, Jones, SD, Jaggers, J, Piedalue, F, Grover, FL, McIntyre, RC Jr. Effective control of pulmonary vascular resistance with inhaled nitric oxide after cardiac operation. J Thorac Cardiovasc Surg 1996; 111: 753–762; discussion 762–753.CrossRefGoogle ScholarPubMed
Latus, H, Gerstner, B, Kerst, Get al.Effect of inhaled nitric oxide on blood flow dynamics in patients after the Fontan procedure using cardiovascular magnetic resonance flow measurements. Pediatr Cardiol 2016; 37: 504–511.CrossRefGoogle ScholarPubMed
Todd Tzanetos, DR, Housley, JJ, Barr, FE, May, WL, Landers, CD.Implementation of an inhaled nitric oxide protocol decreases direct cost associated with its use. Respir Care 2015; 60: 644–650.10.4187/respcare.03308CrossRefGoogle ScholarPubMed
Supplementary material: File

Villarreal et al. Supplementary Materials

Villarreal et al. Supplementary Materials

Download Villarreal et al. Supplementary Materials(File)
File 66 KB