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.
Subject(s)
Bronchodilator Agents/administration & dosage , Infant, Premature, Diseases/therapy , Intensive Care Units, Pediatric , Nitric Oxide/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Inhalation , Antihypertensive Agents/administration & dosage , Epoprostenol/administration & dosage , Humans , Infant , Infant, Newborn , Off-Label UseABSTRACT
Our understanding of albuterol nebulization driven by helium-oxygen mixture (heliox) has matured with recent advances in clinical therapy, delivery systems, and understanding of dosing; this has led to substantial improvements in delivery as well as refinements of research protocols for asthma exacerbations. This review begins with heliox inhalation therapy and then addresses heliox as a driving gas for nebulization. Technical considerations are reviewed, including optimal gas mixtures, flow-rate adjustment factors, and nebulizer setup.
