Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis.
Congenit Heart Dis
; 14(6): 1078-1086, 2019 Nov.
Article
in En
| MEDLINE
| ID: mdl-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. MAINRESULTS:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Care
/
Truncus Arteriosus, Persistent
/
Vascular Resistance
/
Vasodilator Agents
/
Practice Patterns, Physicians'
/
Pulmonary Circulation
/
Cardiac Surgical Procedures
/
Nitric Oxide
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Newborn
Country/Region as subject:
America do norte
Language:
En
Journal:
Congenit Heart Dis
Journal subject:
CARDIOLOGIA
Year:
2019
Document type:
Article