Statement from Dr Andreas Schibler: In Australia, approximately 12’000 children per year are admitted to a paediatric intensive care unit (PICU) of which 2’800 have a cardiac surgical procedure requiring recovery in intensive care.

Most of the evidence for best medical treatment in PICU stems from adult studies and often little is known about what forms best clinical practice for these children admitted to PICU. It is therefore important that high-quality studies are performed in children to guide optimal treatment and removes the uncertainty in what constitutes best care is for this vulnerable population. In case current knowledge does not permit us to make an evidenced-based recommendation between different approaches, most acute care doctors will make decisions based on their experience and uncertainty remains.

The NITRIC study has addressed a known “unknown”, whether children undergoing cardiac surgery do benefit from receiving nitric oxide (an anti-inflammatory drug) during open heart surgery. In our large study enrolling 1371 children across Australia and New Zealand we could not demonstrate any benefit of nitric oxide in children during cardiac surgery.

These findings are important as the study has addressed the uncertainty of the role of nitric oxide in these children and has answered that question. Uncertainty will remain and perpetuate if we do not perform high-quality studies specifically targeted for children. The NITRIC study is part of a series of studies currently performed in Australia and New Zealand that investigate common medical problems in children admitted to PICU.

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