Document Detail

Nitric oxide delivery during high-frequency oscillatory ventilation.
MedLine Citation:
PMID:  10980101     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Inhaled nitric oxide (NO) is used increasingly in the care of infants with hypoxemic respiratory failure and is frequently combined with high-frequency oscillation (HFO). The aim of this study was to evaluate delivery of NO during HFO using titration into the ventilator circuit or using the INOvent Delivery System. METHODS: NO was delivered into the HFO circuit at three sites (pre-humidifier, post-humidifier, and after the bellows) by continuous titration using a rotameter. The target NO concentration ([NO]) was initially adjusted using a rapid-response chemiluminescence NO analyzer without oscillation at 5, 10, and 20 parts per million (ppm). During the study, gas was sampled 5 cm from the bellows (proximal), 35 cm from the bellows (middle), and at the distal end of the circuit (distal). The ventilator was set at frequencies of 5, 10, and 15 Hz, mean airway pressures of 15, 20, and 25 cm H(2)O, and amplitudes of 20, 30, and 40 cm H(2)O. Soft and hard circuits were evaluated. The fraction of inspired oxygen was 0. 90, the inspiratory time fraction was 33%, and the bias flow was 20 L/min throughout the study. An INOvent Delivery System was also evaluated with the same HFO settings. RESULTS: The fluctuation of [NO] was minimal with continuous titration pre-humidifier at all HFO settings. [NO] fluctuated with titration post-humidifier and after the bellows, especially at the proximal sampling site. At the lung model, however, fluctuation of [NO] was always < 1.5 ppm and usually < 1 ppm. Delivered [NO] was lower than target [NO] with injection after the bellows (> 5%). The soft circuit showed better mixing of NO than the hard circuit. The INOvent Delivery System delivered a stable and accurate [NO] at all settings. [NO(2)] was < 1 ppm at all settings. CONCLUSIONS: Mixing of NO during HFO was acceptable at all the injection sites evaluated, although injection pre-humidifier was preferable because of small fluctuations of [NO]. The INOvent Delivery System was simple to use and delivered an accurate and precise [NO] during HFO.
Y Fujino; R M Kacmarek; D R Hess
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Respiratory care     Volume:  45     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-10-02     Completed Date:  2000-11-16     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1097-104     Citation Subset:  IM    
Massachusetts General Hospital, Boston 02114, USA.
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MeSH Terms
Administration, Inhalation
Anoxia / therapy
Bronchodilator Agents / administration & dosage*
Chemiluminescent Measurements
High-Frequency Ventilation / instrumentation*
Infant, Newborn
Models, Biological
Nitric Oxide / administration & dosage*
Respiratory Insufficiency / therapy*
Reg. No./Substance:
0/Bronchodilator Agents; 10102-43-9/Nitric Oxide

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