Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Postoperative hypertension after surgery for congenital heart disease (n=123). Intervention: Nicardipine vs. Nitroprusside. Primary outcome: Achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent (p=0.86).

Q: What does this research mean for the field?

Nicardipine is noninferior to nitroprusside for achieving blood pressure control at 1 hour post-initiation in infants after congenital heart surgery, and is significantly less expensive. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rudolph J. Wong; Allison Mruk; Lisa M. Grimaldi; Reena Patel; Lucia Mirea; K. Engelhardt

doi:10.1097/pcc.0000000000003469

February 1, 2024Pediatric Critical Care Medicine

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

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Key result

Nicardipine matches nitroprusside for 1-hour blood pressure control in infants after congenital heart surgery.

P=0.86
n=123

Why the study?

Postoperative hypertension is common after congenital heart disease surgery, but calcium channel blockers raise safety concerns in infants, while nitroprusside carries costs and side effects.

Does nicardipine achieve noninferior postoperative blood pressure control compared to nitroprusside in infants after surgery for congenital heart disease?

Key Points

To assess whether nicardipine is noninferior to nitroprusside for postoperative blood pressure control in infants following surgery for congenital heart disease and evaluate associated drug costs.
Single-center retrospective, pre-post chart review conducted at an academic quaternary-care center between 2016 and 2020.
Evaluated infants under 1 year of age requiring treatment for hypertension within 24 hours of congenital heart disease surgery treated with nitroprusside (n = 71) or nicardipine (n = 52).
Blood pressure control at 1 hour post-medication initiation was achieved in 54% of nicardipine patients versus 52% of nitroprusside patients (p = 0.86), establishing noninferiority for nicardipine within a 15% margin.
Among patients without control at 1 hour, nicardipine was associated with a higher rate of control at 2 hours compared to nitroprusside (79% vs. 38%; p = 0.003).
No differences were observed in mean Vasoactive-Inotropic Scores, blood transfusion volumes, crystalloid volumes, or calcium requirements, but wholesale-driven index costs were 16 times higher for nitroprusside than nicardipine.

Study Design

Type

Observational (n=123)

Multicenter

No

Structured PICO

Does nicardipine achieve noninferior postoperative blood pressure control compared to nitroprusside in infants after surgery for congenital heart disease?

P

Population

123 infants under 1 year old who required treatment for hypertension within 24 hours of surgery for congenital heart disease

I

Intervention

Nicardipine

C

Comparator

Nitroprusside

O

Outcome

Achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agentsurrogate

Main Result

Absolute Event Rate: 54% vs 52%

p-value: p=0.86

Nicardipine is noninferior to nitroprusside for postoperative blood pressure control in infants after congenital heart surgery, while being significantly less expensive.

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Answers are grounded in this paper and cite their sources.

Implication

May support nicardipine as alternative for infant post-congenital heart surgery BP control; leaves open need for randomized confirmation.

Abstract

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Discussion

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Cite This Study

Wong et al. (2024) conducted an observational in Postoperative hypertension after surgery for congenital heart disease (n=123). Nicardipine vs. Nitroprusside was evaluated on Achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent (p=0.86). Nicardipine was noninferior to nitroprusside for achieving blood pressure control at 1 hour post-initiation in infants after congenital heart surgery (54% vs 52%; p=0.86).

synapsesocial.com/papers/6a10762370f73a8171fca226 https://doi.org/10.1097/pcc.0000000000003469

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Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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