The Association Between Inhaled Nitric Oxide Treatment and ICU Mortality and 28-Day Ventilator-Free Days in Pediatric Acute Respiratory Distress Syndrome*

Bhalla, Anoopindar; Yehya, Nadir; Mack, Wendy J.; Wilson, Melissa L.; Khemani, Robinder G.; Newth, Christopher J L

doi:10.1097/ccm.0000000000003312

Cited by 15 publications

(7 citation statements)

References 21 publications

(21 reference statements)

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“…A 2016 Cochrane review indicated no mortality benefit from iNO administration (RR, 0.78; 95% CI, 0.51-1.18) in three RCTs [297]. Our analysis of two recent observational studies, one conducted in children on ECMO and another in children with severe PARDS, respectively, suggest possible increased mortality risk [294,296], whereas one RCT of 55 PARDS patients indicated improved duration of mechanical ventilation in PARDS survivors [291] ( Supplemental Table 17 and Supplemental Fig. 7, Supplemental Digital Content 1, http://links .lww.com/ PCC/B139).…”

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confidence: 66%

“…Several small RCTs [289][290][291] and observational studies have described significant improvement in oxygenation after iNO therapy [292]. Many, but not all, of these studies include patients with sepsis [290,291,[293][294][295][296], and few analyze longer term, clinically relevant outcomes such as mortality. A 2016 Cochrane review indicated no mortality benefit from iNO administration (RR, 0.78; 95% CI, 0.51-1.18) in three RCTs [297].…”

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confidence: 99%

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Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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confidence: 66%

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Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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“…Given that improved oxygenation has not been shown to improve outcomes, 22,[27][28][29] PALICC recommends oxygen saturation goals of 92%-97% for mild PARDS and 88%-92% and PEEP >10 cm H 2 O for severe PARDS. 20 In patients Tamburro and Kneyber, 53 Day et al, 63 Dobyns et al, 64 Ibrahim et al, 65 Afshari et al, 66 Bhalla et al 67…”

Section: Lung-protective Ventilationmentioning

confidence: 99%

“…66 Consistent with those findings, a recent retrospective cohort study of nearly 500 children with PARDS also demonstrated no improvement in either mortality or ventilator-free days with iNO. 67 Given iNO has not been shown to improve patient outcomes in PARDS, PALICC does not recommend its routine use. 53 However, the guidelines suggest considering iNO in patients with known pulmonary hypertension, severe right ventricular dysfunction, or as a bridge to extracorporeal life support in severe cases.…”

Section: Nitric Oxidementioning

confidence: 99%

The Current State of Pediatric Acute Respiratory Distress Syndrome

Orloff

Turner

Rehder

2019

Pediatric Allergy, Immunology, and Pulmonology

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Pediatric acute respiratory distress syndrome (PARDS) is a significant cause of morbidity and mortality in children. Children with PARDS often require intensive care admission and mechanical ventilation. Unfortunately, beyond lung protective ventilation, there are limited data to support our management strategies in PARDS. The Pediatric Acute Lung Injury Consensus Conference (PALICC) offered a new definition of PARDS in 2015 that has improved our understanding of the true epidemiology and heterogeneity of the disease as well as risk stratification. Further studies will be crucial to determine optimal management for varying disease severity. This review will present the physiologic basis of PARDS, describe the unique pediatric definition and risk stratification, and summarize the current evidence for current standards of care as well as adjunctive therapies.

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“…13 Ventilator-free days (VFDs) are a commonly reported outcome measure in acute respiratory distress syndrome (RDS) trials in both adult and pediatric populations. [18][19][20] There is a paper on VFDs in neonatal VAP. 13 The purpose of this study was to compare the VFDs at 28 days and the shortterm outcomes including crude mortality rate, rates of moderate to severe BPD, need for retinopathy of prematurity (ROP) surgery, and rate of intraventricular hemorrhage (IVH) grades III and IV between neonatal VAP and non-VAP groups.…”

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Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

et al. 2022

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Objective To compare the ventilator-free days (VFDs) at day 28 and the short-term outcomes in neonates with and without ventilator-associated pneumonia (VAP and non-VAP groups). Study Design We performed a cohort study in a Thai neonatal intensive care unit between 2014 and 2020 to identify the VFDs in VAP and non-VAP neonates. Univariate and multivariate analyses were performed. Results The incidences of VAP rates were 5.76% (67/1,163 neonates) and 10.86 per 1,000 (92/8,469) ventilator days. The medians (interquartile ranges) of gestational age and birth weight in the VAP vs non-VAP groups were 31 (27–35) vs 34 (30–38) weeks, and 1,495 (813–2,593) vs 2,220 (1,405–2,940) grams (p < 0.001 both), respectively. The medians (interquartile ranges) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0–16) and 24 (20–26) days (p < 0.001). From the univariate analysis, the lower VFDs, longer ventilator days, and higher rates of moderate to severe bronchopulmonary dysplasia (BPD), postnatal steroids for BPD, length of stay, and daily hospital cost in the VAP group were significantly higher than in the non-VAP group. From the multivariate analysis, the VAP group had significantly lower VFDs (regression coefficient = -10.99, standard error = 1.11, p < 0.001) and higher BPD (adjusted risk ratio 18.70; 95% confidence interval 9.17–39.5, p < 0.001) than the non-VAP group. Conclusion Neonatal VAP lead to lower VFDs and a higher frequency of BPD. A multimodal strategy with a VAP prevention bundle care should be used in indicated cases to reduce the occurrence of neonatal VAP.

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The Association Between Inhaled Nitric Oxide Treatment and ICU Mortality and 28-Day Ventilator-Free Days in Pediatric Acute Respiratory Distress Syndrome*

Cited by 15 publications

References 21 publications

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

The Current State of Pediatric Acute Respiratory Distress Syndrome

Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

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