Inhaled Nitric Oxide via High-Flow Nasal Cannula in Postrepair Congenital Heart Disease Patients With Pulmonary Arterial Hypertension Following Extubation: A Cohort Study With Propensity Score Matching

OBJECTIVE: For pediatric patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH), corrective repair carries a substantial risk of inducing pulmonary hypertensive crisis (PHC). The conventional clinical strategy involves postoperative administration of inhaled nitric oxide (iNO) followed by a gradual tapering process, which is often associated with prolonged postoperative recovery. To address this limitation, this study proposes a fast-weaning strategy: the continuation of iNO delivery via high-flow nasal cannula (HFNC) following extubation. METHODS: between 2019 and 2024. Eligible patients admitted from 2023 to 2024 were assigned to Group 1 (fast-weaning), while those admitted from 2019 to 2022 constituted Group 2 (standard-weaning). For propensity-score matching, the predictive variables included age, preoperative PVRi, and the duration of cardiopulmonary bypass. RESULTS: Following propensity score matching, 22 matched pairs were included in the final analysis. Pulmonary hypertensive crisis recurrence occurred in two of 22 patients (9.1%) in Group 1 and three of 22 patients (13.6%) in Group 2 (p > 0.99). Patients in Group 1 had a significantly shorter duration of mechanical ventilation (18 [8.5, 22.3]) versus 21.5 (19.8, 27.3) hours; p = 0.014) and postoperative intensive care unit length of stay (2 [1, 4]) versus 3 [3, 5] days; p = 0.023). No major postoperative complications were reported in either group. CONCLUSION: Continuing iNO via HFNC following extubation is a safe weaning strategy. It may be associated with faster recovery, providing a potential alternative to conventional protocols.