(760) Retrospective Review of the Use of Inhaled Nitric Oxide in Pediatric Patients With Cardiac Illness

Introduction: Inhaled nitric oxide (iNO) is used extensively in the pediatric cardiac intensive care unit for patients with specific cardio-respiratory pathologies however there is limited available data to indicate the specific utility. This study was undertaken to identify clinical practice and the profiles of patients who benefit from iNO.

Methods: 472 patients receiving iNO across a 6-year period (2016-2022) at a tertiary center were retrospectively followed to determine their responsiveness to iNO therapy. Patients returning from a cardiac operation/heart transplant as well as those using a ventricular assist device or ECMO were screened out. Patients over 21 years of age were also excluded. After screening, 89 patients met criteria for the study.

Results: Of the 89 patients, 31% were started due to poor oxygenation in the context of lung disease, 16% due to pulmonary HTN with heart disease, 16% due to RV dysfunction, 16% to promote pulmonary blood flow (PBF) in the context of congenital heart disease (CHD) like pulmonary stenosis, Tricuspid valve incompetence, 10% in the context of failing Glenn or Fontan physiology and 6% due to idiopathic pulmonary HTN.
79% of patients displayed a therapeutic response to iNO therapy, while 4% did not. During the courses of iNO, 73% of patients were successfully weaned off iNO in a single attempt, 12% required multiple trials for iNO wean and 15% died while on iNO. 27% of patients required pulmonary hypertension medications to be weaned from iNO and 21% of patients were discharged on one of these medications. There was no statistical significance between the reason for initiation and mortality.

Conclusions: Typically, iNO is used in pediatric patients for VQ mismatch in respiratory failure and varying reasons of pulmonary hypertension. Our study indicates that uses of iNO continue to evolve and has multimodal value for therapy in patients with cardiac disease both congenital and otherwise. Majority of patients who were placed on iNO displayed a therapeutic response Interestingly only 20% of these patients were discharged on pulmonary hypertension medications.