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As pediatric use of iNO increased, mortality rates dropped

Smiling-baby-boy

iNO, a colorless odorless gas, is used to treat hypoxic respiratory failure in infants born full-term and near term.

Use of inhaled nitric oxide (iNO) among pediatric patients has increased since 2005 and, during a 10-year time period, mortality rates dropped modestly as the therapeutic approach was applied to a broader range of health ailments, according to an observational analysis presented Feb. 26, 2018, during the 47th Critical Care Congress.

iNO, a colorless odorless gas, is used to treat hypoxic respiratory failure in infants born full-term and near term and also has become an important therapy for acute respiratory distress syndrome and pulmonary hypertension in newborns.

Jonathan Chan, M.D., a Children’s National Health System critical care fellow, analyzed de-identified data from patient visits from January 2005 to December 2015 at 47 children’s hospitals around the nation. Dr. Chan included 18,343 patients in the analysis. Among the findings:

  • As a group, the children had an overall mortality rate of 22.7 percent. The mortality rate dropped from 29.1 percent in 2005 to 21.2 percent in 2015.
  • The median adjusted cost per admission was an estimated $158,740 ($5,846 per patient day).

“This large observational study indicates that the use of iNO grew from 2005 to 2015,” Dr. Chan says. “While hospital stays grew longer during the study period, we saw a decrease in mortality of 0.01 percent per year.”

The highest number of admissions with iNO use included:

Dr. Chan notes that because this is a retrospective observational analysis, the study’s findings should be interpreted as exploratory.

“Off-label use of iNO continues to increase among pediatric patients. And an increasing proportion of admissions are for specialty areas other than neonatal care,” he adds. “Increasing off-label use of iNO is associated with decreased mortality. But it also is associated with an increased length of stay, higher hospital costs and more units of iNO administered.”

47th Critical Care Congress presentation

Monday, Feb. 26, 2018

Darren Klugman and Melissa Jones

Children’s National to host PCICS

On December 6-8, Children’s National Health System will host the 13th Annual International Meeting of the Pediatric Cardiac Intensive Care Society (PCICS) in Washington, D.C. Chaired by Darren Klugman, M.D., Medical Director of the Cardiac Intensive Care Unit at Children’s National, and Melissa B. Jones, CPNP-AC, cardiac critical care nurse practitioner at Children’s National, the conference will center on the care of children with congenital heart disease around the world.

The sessions themselves will focus on a variety of topics, such as:

  • How care delivery models around the world impact management of CHD
  • The impact of medical missions and sustainable program development in low/middle income countries
  • Cutting edge innovation, specifically device and drug development, machine learning technology, and education platforms that are shaping the world of pediatric cardiac critical care around the world
  • Challenging cases, including mechanical support options for the single ventricle patient
  • Team dynamics and the key to team resiliency
Darren Klugman and Melissa Jones

Chaired by Darren Klugman, M.D., Medical Director of the Cardiac Intensive Care Unit at Children’s National, and Melissa B. Jones, CPNP-AC, cardiac critical care nurse practitioner at Children’s National, the conference will center on the care of children with congenital heart disease around the world.

Several doctors from Children’s National will present at the conference, including Richard Jonas, M.D., Division Chief of Cardiac Surgery and Co-Director or the Children’s National Heart Institute, who will give a talk titled Two Wrongs Don’t Make One Right: A Good Single V Is Better Than a Bad 2V.” Dr. Jonas has spent his career studying ways to improve the safety of cardiopulmonary bypass, particularly as it relates to neurological development. His current R01 grant focuses on white matter susceptibility to cardiac surgery. Other ongoing projects include investigating the use of near-infrared spectroscopy to guide surgery, examining the permeability of the blood brain barrier during cardiopulmonary bypass using a porcine model, exploring the cellular and molecular level responses to various bypass strategies and developing appropriate bypass management and adjunctive protection.

Also speaking is John Berger III, M.D., Medical Director of Pulmonary Hypertension Program, Interim Medical Director of the Heart Transplant Program and Acting Chief of the Division of Cardiac Critical Care Medicine. Dr. Berger specializes in treating advanced heart failure, pulmonary hypertension, and congenital heart disease, and will give a talk titled, “Chicken or Egg: Failing Ventricle or Elevated PVR in the Fontan Patient.”

Ricardo A. Munoz, M.D., incoming Chief of the Division of Cardiac Critical Care Medicine, will give a talk titled, Program Development From a Distance: The Art and Science of Telemedicine.”

And, Christine Riley, CPNP-AC, a critical care specialist at Children’s National, will be speaking at the Advanced Practice Provider pre-conference review course as well. She will be giving two talks, titled “Obstruction to Systemic Output (Coarc/IAA),” and “Transposition Variations (D-TGA And DORV/Taussig Bing, also L-TGA).”