Nasally Inhaled Nitric Oxide for Sudden Right-Sided Heart Failure in the Intensive Care Unit: NO Time Like the Present

Ghadimi, Kamrouz; Rajagopal, Sudarshan

doi:10.1053/j.jvca.2018.10.008

Cited by 2 publications

(1 citation statement)

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“…As our results indicate, average inhaled NO concentrations at the trachea are considerably lower and vary with patient breathing pattern. Given the current need for additional prospective studies to evaluate the dose-dependent response to noninvasive nasal NO, 33 accurate predictions of average inhaled NO concentrations are critical. In a previous in vitro study assessing NO delivery across multiple delivery interfaces, DiBlasi et al 34 reported the challenge of predicting delivery through an open interface.…”

Section: Discussionmentioning

confidence: 99%

Inhaled Nitric Oxide: In Vitro Analysis of Continuous Flow Noninvasive Delivery via Nasal Cannula

2020

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BACKGROUND: Inhaled nitric oxide (NO) is most frequently delivered to mechanically ventilated patients in critical care, but it can also be administered noninvasively. The delivered dose and efficiency of continuous flow NO supplied through a nasal cannula has yet to be established. This study aimed to determine the influence of nasal cannula type, supply flow, and breathing pattern on delivered NO using a realistic adult airway replica and lung simulator. METHODS: Simulated breathing patterns were selected to represent rest, sleep, and light exercise, and were varied to investigate the effects of tidal volume and breathing frequency independently. Supplied gas flows targeted tracheal concentrations at rest of 5 or 20 ppm NO and were supplied with 2 L/min O 2. Three different cannulas were tested. Tracheal NO concentrations and NO mass flow past the trachea were evaluated. RESULTS: Cannula type had a minor influence on delivered dose. Tracheal NO concentrations differed significantly based on breathing pattern (P < 0.01); for a target NO concentration of 20 ppm at rest, average inhaled NO concentrations were 23.3 6 0.5 ppm, 36.5 6 1.4 ppm, and 17.2 6 0.3 ppm for the rest, sleep, and light exercise breathing patterns, respectively. For the same test conditions, mass flow of NO past the trachea was less sensitive to breathing pattern: 20.3 6 0.5 mg/h, 19.9 6 0.8 mg/h, and 24.3 6 0.4 mg/h for the rest, sleep, and light exercise breathing patterns, respectively. Mass flow and delivery efficiency increased when minute volume increased. CONCLUSIONS: These results indicate that inhaled NO concentration is strongly influenced by breathing pattern, whereas inhaled NO mass flow is not. NO mass flow may therefore be a useful dose metric for continuous flow delivery via nasal cannula.

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Section: Discussionmentioning

confidence: 99%