Inhaled nitric oxide

Abstract

Nitric oxide (NO) is a gas that induces relaxation of smooth muscle cells in the vasculature. Because NO reacts with oxyhaemoglobin with high affinity, the gas is rapidly scavenged by oxyhaemoglobin in red blood cells and the vasodilating effects of inhaled NO are limited to ventilated regions in the lung. NO therefore has the unique ability to induce pulmonary vasodilatation specifically in the portions of the lung with adequate ventilation, thereby improving oxygenation of blood and decreasing intrapulmonary right to left shunting. Inhaled NO is used to treat a spectrum of cardiopulmonary conditions, including pulmonary hypertension in children and adults. However, the widespread use of inhaled NO is limited by logistical and financial barriers. We have designed, developed and tested a simple and economic NO generation device, which uses pulsed electrical discharges in air to produce therapeutic levels of NO that can be used for inhalation therapy. Linked Articles This article is part of a themed section on Nitric Oxide 20 Years from the 1998 Nobel Prize. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.2/issuetoc

Controlled release of H2S and NO gases through CO2-stimulated anion exchange

“…The potential utility of the gas release system was demonstrated by creating a portable and battery-free respirator that can supply therapeutically useful quantity of NO into inhaled air. NO becomes a selective and fastacting pulmonary vasodilator upon inhalation, and inhaled NO is a well-established method for treating respiratory distress such as persistent pulmonary hypertension of the newborn [33][34][35][36] . However, current inhaled NO is an advanced medical treatment since it requires a high-pressure gas cylinder, expensive medical instrument, and trained operator for controlling/monitoring the purity and dose of NO 35,36 .…”

“…The typical concentration of NO used for treatment of respiratory distress is 5-20 p.p.m. [33][34][35][36] and the respiratory volume of newborns and infants is~0.5-2.5 L min −1 . Although the NO-release systems described in Fig.…”

Inhaled Pulmonary Vasodilators in the Neonatal and Pediatric ICU

“…77 The system uses an antioxidant reactor scrubber that minimizes NO 2 . The AirNOvent (AIT Therapeutics) 78 and eNO (Third Pole Therapeutics) 79,80 are capable of generating INO from ambient air using an electrical discharge (plasma/iridium spark) to create NO 2 , which is converted to nitric oxide using a scrubber that requires daily changing. This on-demand system can produce concentrations of 1-400 ppm without the use of tanks.…”

Administering Inhaled Nitric Oxide: Still More to Understand

“…Inhaled nitric oxide (INO) is a selective pulmonary vasodilator used to manage pulmonary arterial hypertension and ventilation-perfusion mismatch associated with cardiac and pulmonary conditions. 1 In 1999, the Food and Drug Administration approved INO for the treatment of hypoxic respiratory failure in term and near-term newborns, which remains the only on-label application. The safe and accurate administration of this medical gas has been achieved predominantly with the INOmax DS IR Plus (Mallinckrodt, Madison, Wisconsin), a delivery and monitoring device now in its fourth iteration.…”

“…Expanding on this work might also include studying ventilators with leak compensation, as well as neonatal-specific ventilators with NICU to adult ICU capabilities. Additional questions to answer include: (1) To what extent are the observed discrepancies in exhaled V T or _ V E measurement clinically relevant to smaller infants, and what is the optimal method of assessing this phenomenon clinically? ; and (2) Is an animal study evaluating several modern ventilators warranted to determine whether this phenomenon is related solely to measurement error or if a critical threshold exists in which gas exchange is negatively affected?…”