Abstract
BackgroundPostoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5–10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery.MethodsIn this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis.ResultsAmong 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3–47.8) vs. 69.0 h (47.8–110.3), p < 0.001) and ICU stay (122.0 h (80.8–155.0) vs 179.5 h (114.0–258.0), p < 0.001). There were no significant between-group differences in mortality, complications, or length of hospital stay.ConclusionsIn this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.
Highlights
Acute type A aortic dissection (AADA) is a fatal condition
We previously found that inhaled nitric oxide (iNO) improved oxygenation after AADA and tended to decrease the time to extubation [11]
The enrollment criteria were as follows: (I) patients who received repairment surgery for AADA; (II) patients with a persistent postoperative hypoxemia, which was defined as the blood gas exam showed that ratio of arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) was equal to or less than 200 mmHg (PaO2/Fraction of inspired oxygen (FiO2) ≤ 200) occurring within 24 h after intensive care unit (ICU) admission, lasting more than 2 h, and in the absence of other causes of pulmonary insufficiency such as cardiogenic pulmonary edema, pneumonia, pleural effusion, segmental atelectasis, pneumothorax, and pulmonary artery embolism [12]
Summary
Acute type A aortic dissection (AADA) is a fatal condition. The mortality rate is 1–2% per hour on the first day, with nearly 50% of deaths occurring within the first week [1, 2]. Surgery is life-saving for most patients but may result in high postoperative morbidity [1, 2]. Postoperative hypoxemia is a serious complication with an incidence of 30–50% [3, 4]. Hypoxic pulmonary vasoconstriction is inhibited, resulting in ventilation/perfusion mismatching and shunting [7]. Hypoxemia prolongs postoperative mechanical ventilation and intensive care unit (ICU) stay and increases postoperative mortality. Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5–10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery
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