Short Term Efficacy And Safety Of Inhaled Nitric Oxide Treatment For Post-opertative Pulmonary Arterial Hypertension In Infants And Children With Congenital Heart Disease:a Meta-analysis

Objectives: To assess the short term efficacy and safety of inhaled nitricoxide treatment for post-opertative pulmonary arterial hypertension(PAH) ininfants and children with congenital heart disease(CHD).Methods: The United States biomedical databases（MEDLINE OvidSP）,the Holland Medical Abstracts（EMBASE OvidSP）,the Cochrane CentralRegister of Controlled Trials（CENTRAL）,the Chinese Biological MedicalLiterature Database(CBM),the Chinese Knowledge Resources Database(CNKI)and Database of ongoing controlled trials were electronically searched from theestablishment of the database to April2012,to obtain randomized controlled trials(RCTs) of inhaled nitric oxide treatment for PAH in infants and childrenwith CHD.Standard methods of the Cochrane Handbook5.1.2were employed toevaluate the methodological quality of the trials.RevMan5.1software was usedfor Meta-analysis,according to heterogeneity of the included studies to use theproper effective model.If suitable data could not be merged to do aMeta-analysis,descriptive analysis was utilized.Results: A total of984literatures were searched.Six RCTs whichincluded220participants were eligible for this Meta-analysis were enrolled.Theassessment of literature quality showed that two trials in low risk of bias,onewas moderate and three were in high risk of bias.①Meta-analysis indicated thatinhaled nitric oxide treatment significantly reduced sPAP（SMD=-0.83(95%CI=-1.40--0.26,p=0.004), the median time to eligibility for extubationand,themedian time to duration of mechanical ventilation and the median time todischarge from intensive care.②There was no significant difference in mortalityprior to discharge,PAH crisis,mPAP,mSAP,HR, CI and PaO2/FiO2betweentreatment group and control group.③There was a significant increase in themethaemoglobin level in the treatment group（MD=0.40，95%CI=0.20-0.60,p<0.0001).Conclusion: Inhaled nitric oxide can significantly reduced sPAP, themedian time to eligibility for extubationand,the median time to duration ofmechanical ventilation,the median time to discharge from intensive care andwithout any significant adverse effect during short-term follow up.We observed no difference with the use of iNO in the other outcomes reviewed.