The NITRIC Randomized Clinical Trial - Video

Published On 2022-07-01T09:00:36+05:30 | Updated On 1 July 2022 3:23 PM IST

Overview

Now the the international NITRIC trial that is Nitric Oxide During Cardiopulmonary Bypass to Improve Recovery in Infants With Congenital Heart Defects was conducted to test the hypothesis that nitric oxide applied into the cardiopulmonary bypass oxygenator would result in more ventilator-free days than standard care in children undergoing surgery for congenital heart disease.

The study was published in JAMA Network.

It was a double-blind, multicenter, randomized clinical trial conducted in 6 pediatric cardiac surgical centers. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized, with 28-day follow-up period.

Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator or standard care cardiopulmonary bypass without nitric oxide. The primary end point was the number of ventilator-free days from commencement of bypass until day 28 there were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the ICU; length of stay in the hospital; and postoperative troponin levels.

It was found that a total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28.

Therefore, the authors concluded that these findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery meaning that among infants undergoing heart surgery, delivery of nitric oxide into the cardiopulmonary bypass did not increase ventilator-free survival censored at 28 days.

Reference:

Schlapbach LJ, Gibbons KS, Horton SB, et al. Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart DiseaseSurgery: The NITRIC Randomized Clinical Trial. JAMA. Published online June 27, 2022. doi:10.1001/jama.2022.9376

Speakers

Dr. Nandita Mohan

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751