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KMID : 0878620020060010020
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Korean Journal of Pediatric Anesthesia
2002 Volume.6 No. 1 p.20 ~ p.25
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Inhaled No at Pediatric Intensive Care Unit after Operation of Congenital Heart Disease
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Oh Ah-Young
Kim Bo-Kyoung
Kim Kyoung-Ok
Park Chong-Doo
Kim Hee-Soo
Kim Seong-Deok
Kim Chong-Sung
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Abstract
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Background: Right heart failure pulmonary hypertension is a common cause of morbidity and mortality following surgical repair of congenital heart disease. Vasodilators for the treatment of pulmonary hypertension has limited availability because they decrease systemic arterial pressure and increase V/Q mismatch. But inhaled nitric oxide (NO) is a selective pulmonary vasodilator and effective in optimizing V/Q matching by preferentially causing vasodilation in lung units that are well ventilated. We studied retrospectively 10 cases of infants and children who used inhaled NO at PICU immediately after operation of congenital heart disease.
Methods: From June 2001 to December 2001 10 pediatric patients after open heart surgery were treated with inhaled NO. We studied their mean age, sex, weight, diagnosis, starting dose of inhale NO, maximum dose of inhaled NO, duration of inhaled NO, duration of stays at PICU, differences in the PaO2/FIO2 and the ratio of systemic to pulmonary sistolic arterial pressure (PAPsysSAPsys) after inhaled NO.
Results: Their mean age was 4.1±4.3 months, their mean body weight was 4.6±2.4 ㎏. Their diagnosis was 4 VSD & ASD, 2 TAPVC, 1 TOF & PA, 1 Cor Triatrimtum, 1 Double arch and 1 DORV & MS & AS & CoA. Their starting dose of inhaled NO was 19±5.7ppm, the maximum dose of inhaled NO was 28±9.2 ppm, the duration of inhaled NO was 13.5±11.2 days and the duration of PICU stay was 24.6±14.9 days. PaO2/FIO2 increased 71.3±77.9% (n=9, P<0.01) and PAPsysSAPsys decreased 34±12.9% (n=6, P<0.01) after inhaled NO. 5 among 10 pediatric patients who used inhaled NO died.
Conclusions: The use of inhaled NO immediately after operation for congenital heart disease was beneficial in lowering pulmonary artery pressure and in improving oxygenation in patients with pulmonary hypertension. But the effect of inhaled NO on the prognosis of the patients needs further study.
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KEYWORD
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Congenital heart disease, intensive care unit, nitric oxide, pediatric, pulmonary hypertension
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