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Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016-2020.
- Source :
-
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Jun 01; Vol. 25 (6), pp. 538-546. Date of Electronic Publication: 2024 Feb 01. - Publication Year :
- 2024
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Abstract
- Objectives: Postoperative hypertension frequently occurs after surgery for congenital heart disease. Given safety concerns when using calcium channel blockers in infants along with the cost and side-effect profile of nitroprusside, we retrospectively assessed our experience of using nicardipine and nitroprusside for postoperative blood pressure control in infants who underwent surgery for congenital heart disease. We also investigated the cost difference between the medications.<br />Design: This study was a single-center retrospective, pre-post chart review of patients who had surgery for congenital heart disease between 2016 and 2020. The primary aim was a noninferiority comparison of achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent. Secondary comparisons included achievement of blood pressure goal at 2 hours after medication initiation, Vasoactive-Inotropic Score (VIS), and blood transfusion, crystalloid volume, and calcium needs.<br />Setting: Academic quaternary-care center.<br />Patients: Infants under 1 year old who required treatment for hypertension with nitroprusside ( n = 71) or nicardipine ( n = 52) within 24 hours of surgery for congenital heart disease.<br />Interventions: None.<br />Measurements and Main Results: We failed to identify any difference in proportion of patients that achieved blood pressure control at 1-hour after medication initiation (nitroprusside 52% vs. nicardipine 54%; p = 0.86), with nicardipine noninferior to nitroprusside within a 15% margin. Of patients who did not achieve control at 1-hour post-medication initiation, receiving nicardipine was associated with blood pressure control at 2 hours post-medication initiation (79% vs. 38%; p = 0.003). We also failed to identify an association between antihypertensive types and mean VIS scores, blood transfusion volumes, crystalloid volumes, and quantities of calcium administered. Index cost of using nitroprusside was 16 times higher than using nicardipine, primarily due to difference in wholesale cost.<br />Conclusions: In our experience of achieving blood pressure control in infants after surgery for congenital heart disease (2016-2020), antihypertensive treatment with nicardipine was noninferior to nitroprusside. Furthermore, nicardipine use was significantly less expensive than nitroprusside. Our contemporary practice is therefore to use nicardipine in preference to nitroprusside.<br />Competing Interests: Dr. Mirea disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.<br /> (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
- Subjects :
- Humans
Retrospective Studies
Infant
Female
Male
Infant, Newborn
Calcium Channel Blockers therapeutic use
Calcium Channel Blockers economics
Calcium Channel Blockers administration & dosage
Cardiac Surgical Procedures adverse effects
Blood Pressure drug effects
Vasodilator Agents therapeutic use
Vasodilator Agents administration & dosage
Vasodilator Agents economics
Costs and Cost Analysis
Nicardipine therapeutic use
Nicardipine administration & dosage
Nicardipine economics
Nitroprusside therapeutic use
Nitroprusside administration & dosage
Nitroprusside economics
Heart Defects, Congenital surgery
Antihypertensive Agents economics
Antihypertensive Agents therapeutic use
Antihypertensive Agents administration & dosage
Postoperative Complications prevention & control
Postoperative Complications economics
Hypertension drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1529-7535
- Volume :
- 25
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
- Publication Type :
- Academic Journal
- Accession number :
- 38299930
- Full Text :
- https://doi.org/10.1097/PCC.0000000000003469