ArticleCritical care medicine2018
The Association Between Inhaled Nitric Oxide Treatment and ICU Mortality and 28-Day Ventilator-Free Days in Pediatric Acute Respiratory Distress Syndrome.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03611374 (Regional Anesthesia for Cardiothoracic Enhanced Recovery), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Regional Anesthesia for Cardiothoracic Enhanced Recovery (RACER) for Patients Undergoing Sternotomy for Congenital Heart Repair
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Consensus statement of the Paediatric Anaesthesiology and Intensive Therapy Section of the Polish Society of Anaesthesiology and Intensive Therapy on the use of VV ECMO in paediatric patients for the treatment of acute respiratory failure.Anaesthesiology intensive therapy · 2026Article
- Clinical Factors Associated with Ventilator-Free Days in Newborns with Persistent Pulmonary Hypertension of the Newborn: A Retrospective Cohort Study in Thailand.Journal of clinical medicine · 2026Article
- Pediatric Acute Respiratory Distress Syndrome Updates in the Light of the PALICC-2 Guidelines.Turkish archives of pediatrics · 2025Article
- New perspectives on extracorporeal life support: expert teams and precise selection of candidates are transforming pediatric cancer and hematopoietic cell transplantation care.Frontiers in oncology · 2025Article
- Inhaled Nitric Oxide Use and Outcomes in Critically Ill Children With a History of Prematurity.Respiratory care · 2021Observational
- Inhaled Nitric Oxide Use in Pediatric Hypoxemic Respiratory Failure.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Observational
- The Current State of Pediatric Acute Respiratory Distress Syndrome.Pediatric allergy, immunology, and pulmonology · 2019Review
- The authors reply.Critical care medicine · 2018Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo investigate the association between inhaled nitric oxide treatment and ICU mortality and 28-day ventilator-free days in pediatric acute respiratory distress syndrome.
designRetrospective cohort study. A propensity score for inhaled nitric oxide treatment was developed and used in the analysis.
settingTwo quaternary care PICUs. PATIENTS: Children with pediatric acute respiratory distress syndrome.
interventionsNone. MEASUREMENTS AND MAIN
resultsThere were 499 children enrolled in this study with 143 (28.7%) receiving inhaled nitric oxide treatment. Children treated with inhaled nitric oxide were more likely to have a primary diagnosis of pneumonia (72% vs 54.8%; p < 0.001), had a higher initial oxygenation index (median 16.9 [interquartile range, 10.1-27.3] vs 8.5 [interquartile range, 5.8-12.2]; p < 0.001), and had a higher 72-hour maximal Vasoactive-Inotrope Score (median 15 [interquartile range, 6-25] vs 8 [interquartile range, 0-17.8]; p < 0.001) than those not receiving inhaled nitric oxide. Mortality was higher in the inhaled nitric oxide treatment group (25.2% vs 16.3%; p = 0.02), and children in this group had fewer 28-day ventilator-free days (10 d [interquartile range, 0-18 d] vs 17 d (interquartile range 5.5-22 d]; p < 0.0001). We matched 176 children based on propensity score for inhaled nitric oxide treatment. In the matched cohort, inhaled nitric oxide treatment was not associated with mortality (odds ratio, 1.3 [95% CI, 0.56-3.0]) or 28-day ventilator-free days (incidence rate ratio, 0.91 [95% CI, 0.80-1.04]). These results remained consistent in the entire study cohort when the propensity score for inhaled nitric oxide treatment was used for either inverse probability weighting or stratification in regression modeling with the exception that subjects treated with inhaled nitric oxide were more likely to have 0 ventilator-free days (p ≤ 0.02). In secondary analysis stratified by oxygenation response, inhaled nitric oxide treatment was not associated with mortality or 28-day ventilator-free days in children with a positive oxygenation response (all p > 0.2)
conclusions: Treatment with inhaled nitric oxide in pediatric acute respiratory distress syndrome is not associated with improvement in either mortality or ventilator-free days and may be associated with harm. Further prospective trials are required to define the role of inhaled nitric oxide treatment in pediatric acute respiratory distress syndrome.
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