1. INTRODUCTION: Post operative pulmonary hypertension (PH) complicates 2 % of patients undergoing cardiac surgery with pulmonary hypertensive crises (PHC) occurring in 0.75 %. Mortality is as high as 25 % in those suffering a crisis while contributing significantly to in hospital morbidity. We developed a protocol for prevention and management of PHC in the cardiovascular intensive care unit (CVICU) consisting of preemptive use of sedation and nitric oxide. Figure 1. Algorithm for the pulmonary hypertension protocol The demographic variables for both groups are shown in table 1, there was no significant difference between both groups. Table 1. Demographic variables for both groups There was no significant difference in the LOS for either hospital or CVICU between the two groups. There was no statistically significant difference in the cost or use of iNO between two groups. There was no statistically significant difference in the use of sedation between the two groups compared as total dose, max. rate of infusion and number of prn doses of Versed, Morphine and Fentanyl. Duration of mechanical ventilation was shorter in group B (2.3 ± 1.8 days) than group A (4.5 ± 3.8 days) (p value < 0.01) as shown in Figure 2. The use of sildenafil was higher in group B (65.3 %) than in group A (39.0 %) (p value < 0.05 for a one-tailed unpaired t test). A comparison of different outcomes is shown in Table 2. CONCLUSIONS: The pulmonary hypertension protocol has successfully reduced the duration of mechanical ventilation in post-operative cardiac surgical patients in our cardiovascular intensive care unit. Despite the use of a protocol based on preemptive use of inhaled nitric oxide and sedatives, there was no statistically significant difference in the use of either of these outcomes in the post intervention group. There was a higher tendency to use sildenafil in the post intervention group reflecting better awareness and recognition of pulmonary hypertension. USE OF A PROACTIVE PROTOCOL BASED APPROACH TO PREVENTION AND MANAGEMENT OF PULMONARY HYPERTENSIVE CRISES SHORTENS MECHANICAL VENTILATION IN POST OPERATIVE PEDIATRIC CARDIAC PATIENTS IN A TERTIARY CARE CENTER Thomas Yohannan MD 1,2, Juan C. Menendez Ph.D. 1, Vivian Lebaroff RRT 3, Curtis Petty Pharm.D 4, Mayte Figueroa MD 1,2 University of Tennessee Health Science Center. Department of Pediatrics 1. Le Bonheur Children’s Hospital, Divisions of Pediatric Cardiology 2,Respiratory Care 3 and Pharmacy 4 HYPOTHESIS: We hypothesized that the implementation of a standardized PH protocol would reduce morbidity in postoperative cardiac surgery patients. METHODS: Retrospective chart review of all post operative cardiac patients at risk for PHC admitted to CVICU between January 2009 and October 2012. The patients were identified by:  Diagnosis and clinical documentation of PHC.  Preoperative cardiac catheterization Pulmonary Vascular Resistance (PVR) ≥ 3 woods units, mean Pulmonary Artery Pressure (PAP )≥ 25 mm Hg.  Echocardiographic evidence of pulmonary hypertension. PH protocol as depicted in Figure 1 was officially implemented in July 2010. Nursing staff education prior to implementation. Patients were divided into Groups A ( January 2009 to June 2010) and B ( July 2010 to October 2012) (before and after implementation of protocol respectively). The groups were analyzed on the following variables:  Use and cost of inhaled nitric oxide (hours and cost per patient)  Use of sildenafil.  Use of sedation as total dose, max. rate of infusion and number of prn doses of Versed, Morphine and Fentanyl.  Duration of mechanical ventilation (days).  Length of stay (LOS) in CVICU and hospital (days). STATISTICAL ANALYSIS: Unpaired t-test was used to compare both groups for continuous variables. Contingency analysis was used for comparison between the two groups for categorical variables RESULTS: A total of 49 patients were included in the study 23 in group A and 26 in group B. Figure 2. Duration of mechanical ventilation (days) for both groups. Table 2. Comparison of Different Outcomes. VariableGroup AGroup Bp-value Continuous variables [Median (Range)] (t-test comparison). Age ( months)3.0 (0.07 - 24.0)5.0 (0.23 - 24.0)0.19 Weight ( kilograms)4.2 (2.1 - 9.2)5.0 (1.7 - 14.4)0.11 Cardiopulmonary bypass time (minutes)96.0 (47.0 - 172.0)83.5 (37.0 - 232.0)0.34 Aortic cross clamp time (minutes)49.0 (0 - 96.0)32.0 (0 – 69.0)0.22 Nominal variables [frequency] (  2 Pearson test). SexM=9, F=14M=16, F= 100.12 Trisomy 21850.22 Cardiac catheterization(N)6110.23 DescriptionGroup A 1 Group Bp value PRIMARY OUTCOMES Mechanical ventilation (days)4.5 (0.5 - 15.0)2.3 (0.5 - 7.0)0.01 Inhaled nitric oxide ( hours)37.9 (0 - 127.0)41.3 (0 - 152.0)0.73 SECONDARY OUTCOMES Cost of inhaled nitric oxide ($)2238.3 (0 – 7,495.5)2579.9 (0 -10,143.0)0.58 PCICU LOS (days)9.1 (3.0 -24.0)8.9 (3.0-25.0)0.90 Hospital LOS (days)16.1 (6.0 - 49.0)15.5 (5.0 -48.0)0.85 Use of sildenafil (%)39.165.40.05