Inhaled pulmonary vasodilators in the neonatal and pediatric ICU

Abstract

Inhaled pulmonary vasodilators are a powerful tool in the arsenal of therapies designed to treat pulmonary hypertension in pediatrics. Yet only 1 inhaled vasodilator, inhaled nitric oxide (INO), has been approved by the Food and Drug Administration for use in neonates > 34 weeks gestational age with persistent pulmonary hypertension of the newborn. Off-label use of inhaled vasodilators is com-mon in the neonatal and pediatric population despite a lack of evidence. Growing focus on providing evidence-based therapies combined with the increasing cost of INO has led to the exploration of other inhaled pulmonary vasoactive agents. Advancements in technology have led to the creation of nitric oxide generation devices that do not require tanks. This review evaluates the current evidence regarding the use of inhaled vasodilators and INO delivery devices in the neonatal and pediatric intensive care population.