Hussain Walid A, Bondi Deborah S, Shah Pooja, Morgan Sherwin E, Sriram Sudhir, Schreiber Michael D
Section of Neonatology, Department of Pediatrics (WAH), Loyola University Medical Center, Maywood, IL.
Department of Pharmacy (DSB, PS), University of Chicago Medicine Comer Children's Hospital, Chicago, IL.
J Pediatr Pharmacol Ther. 2022;27(3):284-291. doi: 10.5863/1551-6776-27.3.284. Epub 2022 Mar 21.
Inhaled nitric oxide (iNO) is an effective but expensive treatment of pulmonary hypertension in newborns, with limited data regarding weaning. Our institution implemented a multidisciplinary iNO weaning protocol and stewardship to reduce inappropriate use of iNO. The objective of this study was to evaluate our institutional iNO usage before and after implementation.
Single-center study comparing a retrospective control group to a prospective cohort after implementation of an iNO weaning protocol. All infants in the neonatal intensive care unit (NICU) who received iNO during the study timeframe were included. The primary outcome was duration of iNO per course.
A total of 47 courses of iNO occurred during the pre-protocol timeframe compared with 37 courses in the post-protocol timeframe. Median iNO usage per course was 149 hours (IQR, 63-243) in the pre-protocol group versus 59 hours (IQR, 37-122) in the post-protocol group (p = 0.008). Length of stay was significantly longer in the pre-protocol group (p = 0.02), likely related to significantly longer ventilator days in the pre-protocol group (p = 0.02). Compliance with initiation of weaning when recommended per the protocol was 72%, and the incidence of successful weaning was 74%.
The implementation of an iNO weaning protocol in the NICU significantly decreased iNO usage by approximately 60% with no notable negative effects.
吸入一氧化氮（iNO）是治疗新生儿肺动脉高压的一种有效但昂贵的方法，关于撤机的数据有限。我们机构实施了一项多学科的iNO撤机方案及管理措施，以减少iNO的不当使用。本研究的目的是评估实施前后我们机构iNO的使用情况。
一项单中心研究，将实施iNO撤机方案后的前瞻性队列与回顾性对照组进行比较。纳入在研究时间段内新生儿重症监护病房（NICU）接受iNO治疗的所有婴儿。主要结局是每个疗程iNO的使用时长。
在方案实施前的时间段内共发生47个iNO疗程，而在方案实施后的时间段内为37个疗程。方案实施前组每个疗程iNO的中位使用时长为149小时（四分位间距，63 - 243），而方案实施后组为59小时（四分位间距，37 - 122）（p = 0.008）。方案实施前组的住院时间显著更长（p = 0.02），可能与方案实施前组呼吸机使用天数显著更长有关（p = 0.02）。按照方案建议开始撤机的依从率为72%，成功撤机的发生率为74%。
在NICU实施iNO撤机方案可使iNO使用量显著减少约60%，且无明显负面影响。
