Improving respiratory outcomes after pediatric cardiac surgery: New uses for nitric oxide

Abstract

This month's issue of Journal of Cardiac Surgery features a retrospective study on the effect of combining inhaled nitric oxide with high frequency oscillator ventilation to rescue infants who have failed conventional ventilation after congenital heart surgery. This commentary aims to place that study within the context of available published literature on the topic. The PubMed database was queried for all English-language entries between 1995 and 2021 with the terms nitric oxide, congenital heart disease, oscillator, and respiratory failure. The results were then assessed for relevance and impact by the author. From these results, 15 articles were selected for use in this review. The cost of prolonged mechanical ventilation is described. The use of nitric oxide has been used to improve outcomes in hypoxic respiratory failure. High-frequency oscillator ventilation has also been studied in pediatric patients with ARDS. To date, no studies have been published showing the benefit of combining these two modalities in pediatric cardiac surgical patients. The results of this month's study on nitric oxide and high frequency oscillator ventilation are placed in the context of current literature and suggestions for further study are presented. Pediatric patients with hypoxic respiratory failure following congenital heart surgery have a new treatment strategy that appears effective. Further studies to confirm this should be undertaken.