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Dead space ratio as a tool in nitric oxide weaning: a study in pulmonary hypertensive disease

Published online by Cambridge University Press:  09 December 2021

Alvaro D. Garcia ,
Wei Liu ,
Hemant Agarwal Open the ORCID record for Hemant Agarwal [Opens in a new window]  and
William J. Hanna Open the ORCID record for William J. Hanna [Opens in a new window]
Alvaro D. Garcia
Affiliation:
Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Wei Liu
Affiliation:
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
Hemant Agarwal
Affiliation:
Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
William J. Hanna*
Affiliation:
Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
*
Author for correspondence: W. J. Hanna, Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, M14, Cleveland, OH 44121, USA. Tel: 2162134513. E-mail: hannaw@ccf.org
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Abstract

Objectives:

To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis.

Patients:

Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years.

Measurements and Main Results:

Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12).

Conclusions:

Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

Keywords

Pulmonary hypertensiondead space fractioninhaled nitric oxide
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1603 - 1607
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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