Inhalation therapy with nitric oxide synthesized from atmospheric air in the postoperative period of cardiac surgery in children: single-center retrospective cohort study

Abstract

Objectives. To study the clinical efficacy and safety of using the method of synthesis of nitric oxide (NO) from atmospheric air in the postoperative period of cardiac surgery in children with precapillary pulmonary hypertension (PH). Materials and methods. A clinical study with retrospective control included 90 patients (28 newborns and 62 children older than 28 days), including 40 boys and 50 girls, median age 0.25 (0.28; 1.17) years. The following inclusion criteria were determined: signed informed consent of the patientʼs legal representative, underwent heart surgery, mechanical controlled ventilation (MCV), pulmonary artery systolic pressure (PAPsys) ≥ 35 mm Hg. Exclusion criteria: methemoglobinemia, left ventricular failure III — IV, hemorrhagic diathesis. 45 children were included in the study group (inhalation of NO obtained by synthesis from atmospheric air using the AIT-NO-01 device), 45 children were included in the retrospective control group (application of the NO delivery method from cylinders, NOXBOX Mobile device (Bedfont, UK)). There were no differences in anthropometric parameters and severity of baseline precapillary PH between the groups. Results. After one hour of NO inhalation using the AIT-NO-01, a decrease in PAPsys was noted. by 33.3 % (p < 0.001). In the retrospective control group, after one hour of NO inhalation, there was a decrease in PAPsys by 26.7 % (p < 0.001). PAPsys decreased by 10 % or more in 40 (89 %) of patients in the study group and in 38 (84 %) of patients in the retrospective control group, (p = 0.4). Inhalation of NO obtained by the synthesis method from atmospheric air was associated with a shorter duration of MCV compared with the method of supply from cylinders: 12 (2; 28) h versus 14 (12.2; 70.5) h, p = 0.01. The length of ICU stay and postoperative complications rate did not differ in the study groups. There were no differences in the risk and severity of the side effects of NO inhalation therapy (the synthesis of methemoglobin and NO2) between the two methods studied. Conclusion. NO inhalation therapy after cardiac surgery in children using the AIT-NO-01 device has the same effectiveness and safety compared with the method of NO supply from cylinders.