Key result
Pulmonary artery line guidance linked to ~3-day shorter inhaled nitric oxide duration vs empiric therapy.
Why the study?
Inhaled nitric oxide (iNO) is commonly used empirically in the postoperative management of infants after cardiac surgery, prompting evaluation of intraoperative pulmonary artery lines (PAL) to guide selective iNO use.
Does selective use of inhaled nitric oxide guided by pulmonary artery lines reduce iNO usage, duration, and cost compared to empirical iNO treatment in high-risk neonates and infants after cardiac surgery?
Cohort (n=43)
No
Does selective use of inhaled nitric oxide guided by pulmonary artery lines reduce iNO usage, duration, and cost compared to empirical iNO treatment in high-risk neonates and infants after cardiac surgery?
Using pulmonary artery lines placed in the operating room to guide selective inhaled nitric oxide therapy significantly reduces treatment duration and cost compared to empirical use in high-risk infants after cardiac surgery.
Answers are grounded in this paper and cite their sources.
May support selective iNO use to limit duration in high-risk infants post-cardiac surgery; hypothesis-generating and requires randomized validation before adoption.
BACKGROUND Inhaled Nitric Oxide (iNO) is commonly used empirically in postoperative management of infants after cardiac surgery. This study reports benefits of Pulmonary Artery Lines (PAL) inserted in the operating room in guiding iNO use. METHODS We reviewed all neonates and infants at high risk (for iNO therapy) treated at our institution between January 2021-October 2022 (group 1) and from October 2022 through August 2025 (group 2). Group 1 patients were treated empirically with iNO following separation from cardiopulmonary bypass (CPB). Group 2 patients had decisions for iNO use guided by PAL data. RESULTS There was no significant difference in mean patient ages, weights or defects. There were 29 patients in group 1 and 14 patients in Group 2. PAL data indicated iNO use for only 3 / 14 (21%) patients in group 2. Mean duration iNO therapy was shorter for group 2 patients compared to group 1 (1.5 +/- 3.3 days; vs. 4.7 +/- 3.5 days; P=0.007). The cost savings for group 2 vs. group 1 are dramatic and significant (group 1, $17951 vs group 2, $5700; p=0.004). There was 24% mortality in group 1 and 0% mortality in group 2. CONCLUSIONS Targeted management of iNO with PAL inserted in the operating room reduces iNO usage, duration, ICU length of stay, time of mechanical ventilation and cost in high-risk neonates and infants following cardiac surgery.
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Carroll et al. (2026) conducted a cohort in Neonates and infants at high risk for inhaled nitric oxide therapy undergoing cardiac surgery (n=43). Pulmonary artery line (PAL)-guided inhaled nitric oxide (iNO) therapy vs. Empiric inhaled nitric oxide (iNO) therapy following separation from cardiopulmonary bypass was evaluated on Duration of inhaled nitric oxide (iNO) therapy (days) (p=0.007). Pulmonary artery line-guided management reduced mean inhaled nitric oxide duration and cost compared to empiric therapy.
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