Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery

Kırbaş, Ahmet; Yalçın, Yalım; Tanrikulu, Nursen; Gürer, Onur; Işık, Ömer

doi:10.5603/cj.2012.0070

Cited by 22 publications

(23 citation statements)

References 18 publications

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“…In the combined iloprost group, the mean Pp/Ps decreased to 0.34, close to the normal value (<0.30); and the mean Rp/Rs decreased to 0.22, within the normal limit for this parameter (<0.25) . The improvement in mean Pp/Ps before weaning from the ventilator compares very favorably with that reported after extubation by Kirbas et al (0.47) . Further studies will be required to establish whether a reduction in PVR to normal levels immediately after surgery is translated into improved patient outcomes in the long‐term.…”

Section: Discussionsupporting

confidence: 70%

“…10 In a recent study by Kirbas et al, children who underwent surgery for CHD showed a significant reduction in PAP and Pp/Ps from preoperative values, and there were no significant differences between iNO and iloprost in terms of the efficacy and rates of adverse events. 15 In a study by Loukanov et al, after cardiopulmonary bypass surgery there were no significant differences in the frequency of PHC, mPAP values or duration of mechanical ventilation in children treated with either iNO or aerosolized iloprost. 16 Although iloprost and iNO act via different pathways (production of cyclic adenosine monophos-phate and cyclic guanosine monophosphate, respectively), the combination of both agents gave no additional efficacy compared with each agent separately.…”

Section: Discussionmentioning

confidence: 89%

“…In many pediatric intensive care units, iNO is a key pharmacotherapy used in the management of PH, and several studies have compared the efficacy of iloprost with this treatment . In a recent study by Kirbas et al, children who underwent surgery for CHD showed a significant reduction in PAP and Pp/Ps from preoperative values, and there were no significant differences between iNO and iloprost in terms of the efficacy and rates of adverse events . In a study by Loukanov et al, after cardiopulmonary bypass surgery there were no significant differences in the frequency of PHC, mPAP values or duration of mechanical ventilation in children treated with either iNO or aerosolized iloprost .…”

Section: Discussionmentioning

confidence: 99%

“…23 The improvement in mean Pp/Ps before weaning from the ventilator compares very favorably with that reported after extubation by Kirbas et al (0.47). 15 Further studies will be required to establish whether a reduction in PVR to normal levels immediately after surgery is translated into improved patient outcomes in the long-term.…”

Section: Discussionmentioning

confidence: 99%

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Iloprost for children with pulmonary hypertension after surgery to correct congenital heart disease

Zhu

Liu

et al. 2014

Pediatric Pulmonology

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Congenital heart disease (CHD) can cause pulmonary hypertension (PH) in children, and surgery to correct CHD may be complicated by postoperative pulmonary hypertensive crises (PHC). Clinical data regarding the use of inhaled iloprost to treat children with PH are scarce. Our aim was to determine the efficacy and safety of iloprost in children with PH following surgery to correct CHD. This was a randomized, placebo-controlled study of 22 children (median age 7 months) undergoing surgery to achieve biventricular repair. The combined clinical endpoint was a decrease of more than 20% in the ratio of systolic pulmonary arterial pressure to systolic arterial pressure or pulmonary resistance to systemic resistance, with no PHC or death. Patients were randomized to receive low-dose iloprost (30 ng/kg/min), high-dose iloprost (50 ng/kg/min), or placebo, for 10 min every 2 hr in the first 48 hr after surgery. PHC were experienced by two patients who received placebo and one patient treated with high-dose iloprost. The combined clinical endpoint was reached by six patients administered low-dose iloprost (P = 0.005) and four administered high-dose iloprost (P = 0.077), compared with none in the placebo group. Patients treated with iloprost showed a significant reduction from baseline in mean pulmonary vascular resistance index (-2.2 Wood units, P < 0.05), whereas patients who received placebo showed no significant change. This study supports the use of iloprost to treat children with PH following surgery to correct CHD.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Iloprost for children with pulmonary hypertension after surgery to correct congenital heart disease

Zhu

Liu

et al. 2014

Pediatric Pulmonology

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“…oder inhalativem Stickstoffmonoxid behandelt wird [363]. Waren vor der Reanimation Medikamente zur Senkung des pulmonalarteriellen Drucks abgesetzt worden, sollen diese erneut gegeben und zusätzlich inhalatives Epoprostenol oder Stickstoffmonoxid erwogen werden [364][365][366][367][368]. Auch Unterstützungssys-teme für den rechten Ventrikel können die Überlebenswahrscheinlichkeit verbessern [369][370][371][372][373].…”

Section: Pulmonale Hypertonieunclassified