- Inhaled nitric oxide (iNO) does not improve mortality or increase ventilator-free days (VFDs) in pediatric acute respiratory distress syndrome (PARDS).
- There is some evidence for harm from the treatment.
Why this matters
- Among iNO recipients, 61% (87 children) had positive oxygenation response.
- With vs without iNO:
- Mortality: 25.2% vs 16.3% (P=.02);
- Median VFDs: 10 vs 17 (P<.0001>
- Among propensity-matched children (88 pairs), with vs without iNO:
- Adjusting for nonconventional ventilation and extracorporeal membrane oxygenation: similar mortality (OR, 1.3; 95% CI, 0.56-3.0; P=.54);
- In models adjusting for above plus PRISM III score: similar VFDs.
- Some models found higher likelihood of zero VFDs with iNO treatment.
- Observational cohort study of records from Children’s Hospital of Philadelphia and Children’s Hospital Los Angeles (CHLA) (n=499).
- Researchers created propensity score model for children with PARDS who received (n=143) or did not receive iNO in first 72 hours of illness.
- Outcome: pediatric ICU mortality.
- Funding: CHLA.
- Retrospective study, may have been underpowered to detect mortality benefit.