2004 OPEN FORUM Abstracts
A Review Of Inhaled Nitric Oxide Usage in a Children's Hospital
Nancy Craig RRT, Peter Betit RRT, Ravi Thiagarajan MD, David Wessel MD. Children's Hospital and Harvard Medical School, Boston, MA
Background: Inhaled nitric oxide (INO) has been used in our institution
since 1991 as a diagnostic and therapeutic agent in the management
of pulmonary hypertension associated with congenital heart disease
(CHD). It has been subsequently used to treat infants with hypoxic
respiratory failure (HRF), the current FDA approved indication. We
report the use of INO in the era following FDA approval.
Methods: We reviewed our INO database over a 3-year period. Age, indications,
on-label (approved indication) and off-label use, mode of delivery
(MOD), duration of therapy, and medication expenses were recorded
and evaluated from 1/01 to 12/03. INO was delivered either by conventional
mechanical ventilation (CMV), HFOV, a spontaneous breathing circuit,
or nasal cannula. Results: There were 445 patients; [(211) <1
month, (94) 1-12 mos, (50) 1-5 yrs, (44) 6-15 yrs, and (46) >15
yrs]. Indications were 132 HRF, 16 ARDS, 185 CHD, 36 PulmHTN, and
76 diagnostic testing. There were 132 on-label uses and 313 off-label.
The MOD in the on-label group was 78 HFOV and 54 CMV, and in the
off-label group 8 HFOV, 215 CMV, 87 spontaneous breathing circuit,
and 3 nasal cannula. The median duration of use was 25.2 hours (0.1-3432
hrs).
Conclusions: Off-label applications are the predominant use of INO in our institution, with the primary indications being CHD and diagnostic testing. The on-label application of INO remained unchanged. It appears that the average expense per patient was greatest in 2002. The subsequent decrease in expense per patient in 2003 is likely due to a reduction in the typical duration of therapy. We consider the off-label application of INO is an important diagnostic and therapeutic agent in the management of pulmonary hypertension associated with CHD. Future research should be directed at expanding the on-label or approved application.