Inhaled Pulmonary Vasodilators: Are There Indications Within the Pediatric ICU?

Respir Care. 2017 Jun;62(6):678-698. doi: 10.4187/respcare.05360.

Abstract

Inhaled nitric oxide (INO) is only FDA-cleared for neonates (> 34 weeks gestation) with hypoxic respiratory failure-associated pulmonary hypertension. Off-label use of INO is common in the pediatric population despite a lack of evidence regarding survival benefit, questioning whether the therapy should be considered outside the neonatal period. A lack of definitive evidence combined with increasing health-care costs has led to the use of less costly inhaled prostacyclin as an alternative to INO, presenting unique patient safety concerns. We evaluate the current evidence and patient safety considerations regarding inhaled pulmonary vasodilators in the pediatric population.

Keywords: nitric oxide; pediatrics; prostacyclin; pulmonary hypertension.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Antihypertensive Agents / administration & dosage
  • Bronchodilator Agents / administration & dosage*
  • Epoprostenol / administration & dosage
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature, Diseases / therapy*
  • Intensive Care Units, Pediatric*
  • Nitric Oxide / administration & dosage*
  • Off-Label Use
  • Vasodilator Agents / administration & dosage*

Substances

  • Antihypertensive Agents
  • Bronchodilator Agents
  • Vasodilator Agents
  • Nitric Oxide
  • Epoprostenol