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1703 The use of Inhaled Nitric Oxide in a Tertiary Paediatric Intensive Care Unit (PICU)
  1. C Durand1,
  2. S Mahoney2,
  3. S Kerr2,
  4. N Shetty2,
  5. D Buckley2
  1. 1AlderHey Children’s NHS Foundation Trust
  2. 2PICU, AlderHey Children’s NHS Foundation Trust, Liverpool, UK

Abstract

Aims Inhaled nitric oxide (iNO) is used to reduce pulmonary vascular resistance and improve ventilation-perfusion mismatch. This study investigates the use of iNO in a tertiary PICU - Looking at evidence of objective assessment of its benefit (important for weaning/cessation of treatment). iNO costs £40/hour for the first 96 hours & free thereafter. Total spend in this tertiary Children’s Hospital in the UK was approx £240,000 per annum in 2010–11.

Methods All patients receiving iNO were identified. Data was collected prospectively from the bedside (hours on iNO) and retrospectively from case notes/electronic patient records.

Results 107 patient episodes were analysed; 63% were admitted for cardiac surgery and 66% received iNO for < 96hours. Analysis focused on 52 patients over 6 months. Indication for iNO was documented in 75% of cases; 48% of these patients had an echocardiogram prior to iNO. Of those in whom the indication was Pulmonary hypertension 65% had an echo, 35% had no echo. 52% of these were cardiac surgical patients. In those in whom the indication was low oxygen saturations 36% had an echo and 64% no echo. Oxygen saturations and objective improvement measures were not routinely recorded in patient records pre/post iNO.

Conclusions Main indications for iNO were pulmonary hyper-tension (36%) or low oxygen saturations (27%). 48% of patients didn’t have an echo and oxygen saturations were not documented pre/post iNO. The use and effect of an expensive though potentially beneficial drug needs to be assessed and documented to justify its continued use.

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