We have evaluated the kinetics of nitrogen dioxide production in a system for inhalation of nitric oxide. In addition to a small fraction of contamination of nitrogen dioxide in the nitric oxide stock gas, a considerable part of the total concentration of nitrogen dioxide is formed immediately after mixing of nitric oxide and oxygen. This initial build-up of nitrogen dioxide is followed by a linear, time-dependent increase in the concentration of nitrogen dioxide. An equation describing the concentration of nitrogen dioxide in the delivery system is formulated: [NO2] = kA x [NO] + kB x [NO]2 x [O2] + kC x t x [NO]2 x [O2], where nitrogen dioxide [NO2] and nitric oxide [NO] concentrations are in parts per million (ppm), oxygen concentration [O2] is expressed as a percentage and contact time (t) is in seconds. The rate constants are kA = 5.12 x 10(-3), kB = 1.41 x 10(-6) and kC = 0.86 x 10(-6). Calculated nitrogen dioxide values correlated well with measured concentrations. This new finding of an initial build-up of nitrogen dioxide has to be taken into consideration if the conversion of nitric oxide to nitrogen dioxide is to be calculated and in the safety guidelines for the use of nitric oxide.
We have analysed the ability of three nitrogen dioxide absorbing materials (soda lime, noXon and zeolite) to act as nitrogen dioxide scavengers during delivery of inhaled nitric oxide. Different mixtures of gas were produced in a ventilator (Servo Ventilator 300) and passed through an inspiratory tube. Concentrations of nitrogen dioxide and nitric oxide were measured in the distal part of the tube, with and without the gas having passed through a canister containing the different filter materials. Our findings indicated that nitrogen dioxide was absorbed effectively by all filter materials but that there was re-formation of nitrogen dioxide from nitric oxide and oxygen in or immediately after the canister. This initial production of nitrogen dioxide was very rapid and could not be prevented by the use of scavengers. Thus soda lime and zeolite had no practical effect as scavengers in this delivery system, and the effect of noXon was very slight.
An accurate precision in delivered nitric oxide concentration was achieved during intermittent flow ventilation, and this accuracy was independent of tested ventilator settings. The delivery system administered an almost stable concentration throughout a respiratory cycle and during long-term delivery. If the mixing point is in the inspiratory part of the ventilator, valid measurement of nitric oxide and nitrogen dioxide delivery concentrations are possible. Both techniques for measuring nitric oxide and nitrogen dioxide have drawbacks.
Concentrations of nitric oxide and oxygen, minute volume ventilation, and residence time in the inspiratory part of the ventilatory circuit were factors that affected the generation of nitrogen dioxide. A soda lime absorber in this system is not recommended.
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