Journal article
Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis
Congenital heart disease, Vol.14(6), pp.1078-1086
11/01/2019
DOI: 10.1111/chd.12849
PMID: 31713327
Abstract
Background Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR. Objectives We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period. Design Retrospective cohort study. Setting 15 tertiary care pediatric referral centers. Patients All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. Interventions Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use. Main Results We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p = .02) were independently associated with iNO use. Conclusions In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.
Details
- Title: Subtitle
- Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis
- Creators
- Christine M. Riley - Children's NationalChristopher W. Mastropietro - Riley Hospital for ChildrenPeter Sassalos - C. S. Mott Children's HospitalJason R. Buckley - Medical University of South CarolinaJohn M. Costello - Medical University of South CarolinaIlias Iliopoulos - Cincinnati Children's Hospital Medical CenterAimee Jennings - Seattle Children'sKatherine Cashen - Wayne State UniversitySukumar Suguna Narasimhulu - University of Central FloridaKeshava M. N. Gowda - Cleveland ClinicArthur J. Smerling - Morgan Stanley Children's HospitalMichael Wilhelm - University of Wisconsin–MadisonAditya Badheka - Department of Pediatrics, Division of Critical Care Medicine University of Iowa Stead Family Children's Hospital Iowa City IowaAdnan Bakar - Hofstra UniversityElizabeth A. S. Moser - Indiana UniversityVenu Amula - Primary Children's HospitalCollaborative Research in Pediatric Cardiac Intensive Care (CoRe‐PCIC) Investigators
- Resource Type
- Journal article
- Publication Details
- Congenital heart disease, Vol.14(6), pp.1078-1086
- DOI
- 10.1111/chd.12849
- PMID
- 31713327
- NLM abbreviation
- Congenit Heart Dis
- ISSN
- 1747-079X
- eISSN
- 1747-0803
- Publisher
- Wiley
- Number of pages
- 9
- Grant note
- Department of Pediatrics at Indiana University School of Medicine through a Riley Children's Foundation
- Language
- English
- Date published
- 11/01/2019
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984354150802771
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