Inhaled Nitric Oxide via High-Flow Nasal Cannula in Postrepair Congenital Heart Disease Patients With Pulmonary Arterial Hypertension Following Extubation: A Cohort Study With Propensity Score Matching.

OBJECTIVE

For pediatric patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH), corrective repair carries a substantial risk of inducing pulmonary hypertensive crisis (PHC). The conventional clinical strategy involves postoperative administration of inhaled nitric oxide (iNO) followed by a gradual tapering process, which is often associated with prolonged postoperative recovery. To address this limitation, this study proposes a fast-weaning strategy: the continuation of iNO delivery via high-flow nasal cannula (HFNC) following extubation.

METHODS

This single-center, retrospective cohort study screened pediatric patients with systemic-to-pulmonary artery shunt type CHD and a pulmonary vascular resistance index (PVRi) > 6 WU × m2 between 2019 and 2024. Eligible patients admitted from 2023 to 2024 were assigned to Group 1 (fast-weaning), while those admitted from 2019 to 2022 constituted Group 2 (standard-weaning). For propensity-score matching, the predictive variables included age, preoperative PVRi, and the duration of cardiopulmonary bypass.

RESULTS

Following propensity score matching, 22 matched pairs were included in the final analysis. Pulmonary hypertensive crisis recurrence occurred in two of 22 patients (9.1%) in Group 1 and three of 22 patients (13.6%) in Group 2 (p > 0.99). Patients in Group 1 had a significantly shorter duration of mechanical ventilation (18 [8.5, 22.3]) versus 21.5 (19.8, 27.3) hours; p = 0.014) and postoperative intensive care unit length of stay (2 [1, 4]) versus 3 [3, 5] days; p = 0.023). No major postoperative complications were reported in either group.

CONCLUSION

Continuing iNO via HFNC following extubation is a safe weaning strategy. It may be associated with faster recovery, providing a potential alternative to conventional protocols.