Inhalation therapy with nitric oxide synthesized from atmospheric air in the postoperative period of cardiac surgery in children: single-center retrospective cohort study

Abstract

Objectives. To study clinical effectiveness and safety of the method of nitric oxide (NO) synthesized from atmospheric air in the postoperative period for children with precapillary pulmonary arterial hypertension (PAH). Materials and methods. There were 90 patients included into a single-center retrospective cohort study. 28 were newborns and 62 older than 28 days, 30 male and 50 female with a median age of 0.25 (0.28; 1.17) years. Inclusion criteria: informed consent, signed by the official representative, cardiac surgery, mechanical controlled/support ventilation, systolic pulmonary arterial pressure (PAPsys) > 35 mm Hg. Exclusion criteria: methemoglobinemia, heart failure III-IV NYHA, bleeding diathesis. 45 children in the study group were inhaled NO synthesized by АИТ-NO-01 device and the other 45 (retrospective control group) were inhaled NO from the cylinder via NOXBOX device (Bedfond, Great Britain). There were no significant difference between the groups in terms of anthropometric measures and initial precapillary PH. Results. After 1 hour of inhalation of NO by АИТ-NO-01 there PAPsys decreased by 33.3 % (p < 0.001). In the retrospective control group after 1 hour of NO inhalation PAPsys decreased by 26.7 % (p < 0.001). PAPsys decreased by more than 10 % in 89 % patients from the study group and 84 % of patients from the retrospective control group (p = 0.4). There were no significant influence of NO inhalation on the systemic hemodymanic (BP, HR, CVP) either with the use of АИТ-NO-01 or with the use of NO from the cylinder. The inhalation of NO synthesized by АИТ-NO-01 from the atmospheric air was associated with less invasive mechanical ventilation duration than when in the control group: 12 (2; 28) vs. 14 (12.2; 70.5) h; p = 0.01. Length of ICU stay and postoperative complications risks were comparable in both groups. There were no difference in NO therapy complications (methemoglobin and carbon dioxide production) either with delivery of synthesized NO or with cylinder NO use. Conclusions. Inhalation of NO after cardiac surgery in children with АИТ-NO-01 in as efficient and as safe as cylinder NO use.