Comparison of inhaled nitric oxide with aerosolized iloprost for treatment of pulmonary hypertension in children after cardiopulmonary bypass surgery

Clin Res Cardiol. 2011 Jul;100(7):595-602. doi: 10.1007/s00392-011-0284-5. Epub 2011 Feb 13.


Objectives: Pilot study to compare the effect of inhaled nitric oxide (iNO) and aerosolized iloprost in preventing perioperative pulmonary hypertensive crises (PHTCs).

Background: Guidelines recommend the use of iNO to treat PHTCs, but treatment with iNO is not an ideal vasodilator. Aerosolized iloprost may be a possible alternative to iNO in this setting.

Methods: Investigator-initiated, open-label, randomized clinical trial in 15 infants (age range 77-257 days) with left-to-right shunt (11 out of 15 with additional trisomy 21), and pulmonary hypertension (i.e. mean pulmonary artery pressure [PAP] >25 mmHg) after weaning from cardiopulmonary bypass. Patients were randomized to treatment with iNO at 10 ppm or aerosolized iloprost at 0.5 µg/kg (every 2 h). The observation period was 72 h after weaning from cardiopulmonary bypass. The primary endpoint was the occurrence of PHTCs; the secondary endpoints were mean PAP, duration of mechanical ventilation, safety of administration, and in-hospital mortality.

Results: Seven patients received iNO and eight patients received iloprost. During the observation period, 13 of the 15 patients had at least one major or minor PHTC. There was no difference between the groups with regard to the frequency of PHTCs, mean PAP and duration of mechanical ventilation (p > 0.05).

Conclusions: In this pilot study, aerosolized iloprost had a favorable safety profile. Larger trials are needed to compare its efficacy to iNO for the treatment of perioperative pulmonary hypertension. However, neither treatment alone abolished the occurrence of PHTCs.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Bronchodilator Agents / therapeutic use
  • Cardiopulmonary Bypass / adverse effects*
  • Heart Diseases / congenital
  • Heart Diseases / surgery*
  • Humans
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / prevention & control*
  • Iloprost / therapeutic use*
  • Infant
  • Nitric Oxide / therapeutic use*
  • Pilot Projects
  • Postoperative Complications*
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Bronchodilator Agents
  • Vasodilator Agents
  • Nitric Oxide
  • Iloprost