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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 February;39(1):79-86

CARDIAC PAPERS 

    ORIGINAL ARTICLES

Inhaled ­nitric ­oxide in ­infants and chil­dren ­after ­open ­heart sur­gery

Zobel G., Gamillscheg A.*, Schwinger W., Berger J.**, Urlesberger B., Dacar D.***, Rigler B.***, Metzler H.**, Beitzke A.*

From ­the Departments of Pediatrics, *Pediatric Cardiology, **Cardiac ­and Vascular Anesthesia, *** Cardiac Surgery University of Graz, Austria

Objective. To ass­ess ­the ­effects of ­inhaled ­nitric ­oxide (NO) on oxy­gen­a­tion ­and pul­mo­nary cir­cu­la­tion in ­infants ­and chil­dren ­with crit­i­cal pul­mo­nary per­fu­sion ­and/or hypox­e­mia ­after ­open ­heart sur­gery.
Study. A pros­pec­tive ­case ­series ­report.
Setting. A mul­ti­dis­ci­pli­nary pedi­at­ric inten­sive ­care ­unit in a University hos­pi­tal.
Patients. From June 1993 to March 1996 37 pedi­at­ric ­patients ­after ­open ­heart sur­gery ­were treat­ed ­with ­inhaled NO. Their ­mean ­age ­was 2.9±0.6 ­years, ­their ­mean ­body ­weight 12.6±1.8 kg.
Methods. Inhaled NO ­was ­applied ­using a micro­pro­ces­sor con­trolled deliv­ery ­system ­which con­tin­u­ous­ly meas­ured NO ­and NO2 by ­the chem­ilum­nis­cence meth­od. Monitoring includ­ed ­ECG, con­tin­u­ous ­pulse oxim­e­try (SaO2), arte­ri­al (AP), cen­tral ­venous (­CVP) ­and ­left atri­al (­LAP) pres­sures ­and in 8 ­patients a pul­mo­nary ­artery (­PAP) pres­sure. Inhaled NO ­was start­ed at an SaO2 <90% ­with a frac­tion of ­inspired oxy­gen con­cen­tra­tion (FiO2) >0.7, at a ­mean pul­mo­nary ­artery pres­sure (­MPAP) >50% of ­the ­mean arte­ri­al pres­sure (­MAP), ­and in ­patients ­after Fontan-pro­ce­dure at a ­CVP-­LAP pres­sure gra­di­ent >10 mmHg.
Results. The ­mean ­dose of ­inhaled NO ­was 3.7±0.3 ­ppm ­and ­the ­mean dura­tion ­was 112±14.7 ­hours. For ­the ­whole ­group SaO2 ­increased ­from 79.6±2.3 to 90.1±1.5% (p<0.01) with­in 20 min­utes of NO-inha­la­tion. Inhaled NO sig­nif­i­cant­ly ­decreased ­the ­MPAP ­from 47.8±4 to 27.5±2.3 mmHg (p<0.01) in 8 ­patients ­with post­op­er­a­tive pul­mo­nary hyper­ten­sion ­and sig­nif­i­cant­ly ­decreased ­the trans­pul­mo­nary pres­sure (CVP-­LAP) ­from 14.3±0.8 to 7.3±0.9 mmHg (p<0.01) in 16 ­patients ­after Glenn- or Fontan-pro­ce­dure.
Conclusions. Inhaled NO is ­very effec­tive to ­decrease pul­mo­nary ­artery pres­sure, to ­improve oxy­gen­a­tion, ­and to ­improve Fontan-cir­cu­la­tion in ­infants ­and chil­dren ­after ­open ­heart sur­gery.

language: English


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