Comparison of inhaled nitric oxide with aerosolized iloprost for treatment of pulmonary hypertension in children after cardiopulmonary bypass surgery
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- Loukanov, T., Bucsenez, D., Springer, W. et al. Clin Res Cardiol (2011) 100: 595. doi:10.1007/s00392-011-0284-5
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Pilot study to compare the effect of inhaled nitric oxide (iNO) and aerosolized iloprost in preventing perioperative pulmonary hypertensive crises (PHTCs).
Guidelines recommend the use of iNO to treat PHTCs, but treatment with iNO is not an ideal vasodilator. Aerosolized iloprost may be a possible alternative to iNO in this setting.
Investigator-initiated, open-label, randomized clinical trial in 15 infants (age range 77–257 days) with left-to-right shunt (11 out of 15 with additional trisomy 21), and pulmonary hypertension (i.e. mean pulmonary artery pressure [PAP] >25 mmHg) after weaning from cardiopulmonary bypass. Patients were randomized to treatment with iNO at 10 ppm or aerosolized iloprost at 0.5 µg/kg (every 2 h). The observation period was 72 h after weaning from cardiopulmonary bypass. The primary endpoint was the occurrence of PHTCs; the secondary endpoints were mean PAP, duration of mechanical ventilation, safety of administration, and in-hospital mortality.
Seven patients received iNO and eight patients received iloprost. During the observation period, 13 of the 15 patients had at least one major or minor PHTC. There was no difference between the groups with regard to the frequency of PHTCs, mean PAP and duration of mechanical ventilation (p > 0.05).
In this pilot study, aerosolized iloprost had a favorable safety profile. Larger trials are needed to compare its efficacy to iNO for the treatment of perioperative pulmonary hypertension. However, neither treatment alone abolished the occurrence of PHTCs.
KeywordsCongenital heart disease Surgery Pulmonary hypertension Children
Inhaled nitric oxide
Fraction of inspired oxygen
Ratio of pulmonary to systemic blood flow
Partial arterial pressure of carbon dioxide
Partial arterial pressure of oxygen
Pulmonary arterial pressure
Ratio of pulmonary to systemic blood pressure
Parts per million
Pulmonary vascular resistance
Pulmonary hypertensive crisis