Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis.
Administration, Inhalation
Cardiac Surgical Procedures
/ adverse effects
Female
Humans
Infant, Newborn
Male
Nitric Oxide
/ administration & dosage
Postoperative Care
/ trends
Practice Patterns, Physicians'
/ trends
Pulmonary Circulation
/ drug effects
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Truncus Arteriosus, Persistent
/ diagnostic imaging
United States
Vascular Resistance
/ drug effects
Vasodilator Agents
/ administration & dosage
circulatory arrest
congenital
deep hypothermia induced
heart defects
multicenter study
nitric oxide
postoperative period
truncus arteriosus
Journal
Congenital heart disease
ISSN: 1747-0803
Titre abrégé: Congenit Heart Dis
Pays: United States
ID NLM: 101256510
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
25
06
2019
revised:
14
08
2019
accepted:
11
09
2019
pubmed:
13
11
2019
medline:
1
7
2020
entrez:
13
11
2019
Statut:
ppublish
Résumé
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. 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. Retrospective cohort study. 15 tertiary care pediatric referral centers. All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
METHODS
Retrospective cohort study.
SETTING
METHODS
15 tertiary care pediatric referral centers.
PATIENTS
METHODS
All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016.
INTERVENTIONS
METHODS
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
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
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.
Substances chimiques
Vasodilator Agents
0
Nitric Oxide
31C4KY9ESH
Types de publication
Journal Article
Multicenter Study
Langues
eng
Pagination
1078-1086Subventions
Organisme : Department of Pediatrics at Indiana University School of Medicine
Organisme : Riley Children's Foundation
Informations de copyright
© 2019 Wiley Periodicals, Inc.
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