Padayachee S, Salie S
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa.
Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
South Afr J Crit Care. 2021 Aug 6;37(2). doi: 10.7196/SAJCC.2021.v37i2.416. eCollection 2021.
Inhaled nitric oxide (iNO) functions as a selective pulmonary vasodilator. It is an expensive treatment that is often employed as rescue therapy for refractory hypoxaemia in acute respiratory distress syndrome (ARDS) and pulmonary hypertension (PHT) following cardiac surgery.
To describe the use of iNO and the cost of treatment in our paediatric intensive care unit (PICU).
A retrospective descriptive study of all patients treated with iNO in the PICU at Red Cross War Memorial Children's Hospital (RCWMCH) from 2011 - 2015.
We treated 140 patients with iNO, 82 for PHT following cardiac surgery, 53 for ARDS and 5 for persistent pulmonary hypertension of the newborn (PPHN). A response to treatment was observed in 64% of the cohort as a whole, 80% of those with PPHN, 67% of those with PHT post-cardiac surgery, and 64% of those with ARDS. A longer duration of PICU and hospital admission, and higher in-hospital mortality (53%), was seen in the group with ARDS, in particular those with adenoviral infection (63%), when compared with patients treated for PHT post-cardiac surgery (18%) and for PPHN (20%). The total cost of treatment with iNO was ZAR1 441 376 for the 5-year period studied. There are no protocols guiding the use of iNO in our unit, and it was found that response to treatment was not being objectively measured and documented, and that practice varied between clinicians.
Considering the cost of treatment and lack of evidence showing improved outcomes with iNO therapy, its continued use in our resource-limited setting should be guided by protocol.
There is a paucity of data regarding the indications for use, and outcomes of patients treated with iNO in resource-limited settings. We did not find evidence of improved outcomes in patients treated with iNO despite the high costs of the therapy. Protocols should be developed to guide the use of iNO in resource-limited settings.
吸入一氧化氮（iNO）作为一种选择性肺血管扩张剂发挥作用。它是一种昂贵的治疗方法，常用于急性呼吸窘迫综合征（ARDS）难治性低氧血症以及心脏手术后肺动脉高压（PHT）的抢救治疗。
描述iNO在我们儿科重症监护病房（PICU）的使用情况及治疗费用。
对2011年至2015年在红十字战争纪念儿童医院（RCWMCH）的PICU接受iNO治疗的所有患者进行回顾性描述性研究。
我们共治疗了140例使用iNO的患者，其中82例为心脏手术后的PHT，53例为ARDS，5例为新生儿持续性肺动脉高压（PPHN）。总体队列中有64%的患者对治疗有反应，PPHN患者中有80%，心脏手术后PHT患者中有67%，ARDS患者中有64%。与心脏手术后PHT患者（18%）和PPHN患者（20%）相比，ARDS组患者的PICU和住院时间更长，院内死亡率更高（53%），尤其是腺病毒感染患者（63%）。在研究的5年期间，iNO治疗的总费用为1441376南非兰特。我们科室没有指导iNO使用的方案，且发现对治疗反应未进行客观测量和记录，临床医生之间的做法也存在差异。
考虑到治疗费用以及缺乏证据表明iNO治疗能改善预后，在我们资源有限的环境中，其持续使用应以方案为指导。
在资源有限的环境中，关于iNO使用指征及接受iNO治疗患者的预后数据匮乏。尽管治疗费用高昂，但我们未发现iNO治疗患者预后改善的证据。应制定方案以指导资源有限环境中iNO的使用。
