Postoperative nitric oxide therapy in children with congenital heart disease - Can the need be predicted?

The necessity for postoperative inhaled nitric oxide (NO) therapy and predi ctive factors for that need were retrospectively analysed in 457 paediatric patients at risk of pulmonary hypertensive events following open-heart sur gery for congenital heart disease. Inhaled NO was given postoperatively to 46% of the study group and to 23% of all patients undergoing open-heart sur gery during the study period. Factors associated with increased need for po stoperative NO were age <1 year, Down's syndrome, preoperative pulmonary hy pertension and increased pulmonary vascular resistance. Using a multivariat e model based on these factors, 73% of the patients who were given NO were identified. Thus, in a setting with unrestricted access to NO therapy, almo st half of the patients with cardiac lesions that commonly give rise to pos toperative pulmonary hypertension were given postoperative NO. Seventy-thre e percent of postoperative NO treatment was associated with a relatively sm all number of pre- and perioperative patient-related risk factors.