Technical considerations for inhaled nitric oxide therapy: time response to nitric oxide dosing changes and formation of nitrogen dioxide

Breuer, Johannes; Waidelich, F.; Brenndorff, C. Irtel von; Sieverding, Ludger; Rosendahl, W; Baden, Winfried; Gass, Matthias; Apitz, J

doi:10.1007/s004310050639

Cited by 17 publications

(9 citation statements)

References 6 publications

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“…Current methods of administration of NO require cumbersome apparatus, closed systems, continuous suction, and absorbers in various combinations 21. NO has been administered via endotracheal tubes in intubated, mechanically ventilated, frequently paralysed and sedated patients 22.…”

Section: Discussionmentioning

confidence: 99%

Use of nitric oxide inhalation in chronic obstructive pulmonary disease

Kumar

Phadke

Jackson

et al. 2000

Thorax

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Background-Inhalation of nitric oxide with oxygen could be a promising treatment in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension. However, the current methods of delivery of NO are cumbersome and unsuitable for long term use. The present study was undertaken to investigate the safety and eYcacy of a mixture of nitric oxide (NO) and oxygen administered via a nasal cannula for 24 hours in patients with oxygen dependent COPD. Methods-Twenty five parts per million (ppm) of NO was administered by inhalation combined with supplemental oxygen at a flow rate of 2 l/min via a nasal cannula for 24 hours to 11 ambulatory men with stable, oxygen dependent COPD. Room air with supplemental oxygen at 2 l/min was administered in an identical manner for another 24 hours as control therapy in a randomised, double blind, crossover fashion to all patients. Pulmonary function tests, exercise tolerance, dyspnoea grade, and lung volumes were measured at baseline, 24, and 48 hours. Pulmonary artery pressure (PAP), cardiac output (CO), pulmonary vascular resistance (PVR), arterial blood gas tensions, and minute ventilation were measured at baseline, after 30 minutes and 24 hours of breathing NO and oxygen. Venous admixture ratio (Qs/Qt) and dead space ratio (Vd/Vt) were also calculated. Concentrations of nitrogen dioxide (NO 2 ) and NO in the inhaled and ambient air were monitored continuously. DiVerences in pulmonary function, arterial blood gas tensions, pulmonary haemodynamics, exercise tolerance, and dyspnoea between oxygen and NO breathing periods were analysed for significance using paired t tests.

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Section: Discussionmentioning

confidence: 99%

Use of nitric oxide inhalation in chronic obstructive pulmonary disease

Kumar

Phadke

Jackson

et al. 2000

Thorax

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“…Eine Obergrenze von 25 ppm NO über acht Stunden wird in den USA als nicht gesundheitsschädlich betrachtet [29]. Für das Nitrit (NO 2 ), den Hauptvertreter der zytotoxischen Oxidationsprodukte des NO, wird eine Konzentration unter 5 ppm in der Einatemluft gefordert [12,59]. Unter einer Beatmungstherapie werden selten Konzentrationen über 0,5 ± 1 ppm nachgewiesen.…”

Section: Toxizität Von Inounclassified

Die Inhalation von Stickstoffmonoxid in der Neonatologie: Stellenwert dieser Therapie im Jahre 2004

Wirbelauer¹,

Speer²

2004

Z Geburtshilfe Neonatol

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In the late 1970 s it was demonstrated that nitric oxide (NO) was involved in the regulation of vasomotor tone. In Europe inhaled NO (iNO) was approved as a therapy option for the treatment of pulmonary hypertension in term and slightly preterm (> 34 weeks of gestation) neonates. Therapy by iNO mainly reduces the necessity for treatment by extracorporeal membrane oxygenation. However, the mortality of the underlying disease is not affected. According to our current knowledge iNO therapy for term and slightly preterm (> 34 weeks of gestation) neonates does not represent an additional risk factor for the neurological development. Today, iNO therapy constitutes the gold standard for pulmonary hypertension in new-born babies. However, the 30 % non-responders warrant a continued search for alternative treatment concepts. Prophylactic therapy according to a risk profile has not yet proved to be meaningful. An indication for the treatment of preterm neonates of less than 34 weeks of gestation has not yet been confirmed.

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“…O NO 2 pode, também, comprometer a eficiência das defesas pulmonares 2 . A taxa de produção do NO 2 depende da dose do NOi, FiO 2 utilizada e duração do tratamento com o gás, sendo a quantidade do NO 2 formado 1,1% da dose do NOi 57 . Assim, é fundamental monitorar os níveis de NOi e de NO 2 .…”

Section: Precauções E Efeitos Adversosunclassified

Inhaled nitric oxide in pediatrics

Fioretto

2003

J Pediatr (Rio J)

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ResumoObjetivo: Rever a literatura sobre óxido nítrico inalatório e descrever suas principais indicações clínicas em pediatria. Fontes dos dados:Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados Medline (últimos dez anos) e a base de dados Cochrane de revisões sistemáticas. Síntese dos dados:A revisão incluiu os seguintes tópicos: introdução; metabolismo e efeitos biológicos; aplicações clínicas; dose, administração e retirada do gás; precações e efeitos adversos e contra-indicações. Quanto às aplicações clínicas, foram descritos o uso de óxido nítrico em hipertensão pulmonar persistente e insuficiência respiratória de recém-nascidos, síndrome do desconforto respiratório agudo, hipertensão pulmonar primária, cirurgia cardía-ca, doença pulmonar obstrutiva crônica, anemia falciforme e broncoespasmo. Conclusões:O óxido nítrico inalatório é um tratamento com amplas possibilidades de utilização em clínica pediátrica. Seu uso é seguro em ambiente de terapia intensiva sob monitorização rigorosa. Como vasodilatador pulmonar seletivo, o óxido nítrico tem efeitos benéficos sobre as trocas gasosas e ventilação. Estudos controlados que enfoquem a administração precoce do gás são necessários em muitas condições, principalmente na síndrome do desconforto respiratório agudo.J Pediatr (Rio J) 2003;79(Supl.2):S177-S186: Óxido nítrico inalatório, pediatria, hipertensão pulmonar, ventilação mecânica. AbstractObjective: To review the literature on inhaled nitric oxide and to describe its main clinical applications in pediatrics. Sources of data:A 10 year literature review with selection of the most important publications on inhaled nitric oxide, using the Medline and Cochrane Systematic Review databases. Summary of the findings:This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning; precautions and side-effects. Inhaled nitric oxide use was described in persistent pulmonary hypertension and hypoxia of the newborn, acute respiratory distress syndrome, primary pulmonary hypertension, heart surgery, chronic obstructive pulmonary disease, sickle cell anemia, and bronchospastic disease. Conclusions:Inhaled nitric oxide is a therapeutic approach with wide clinical applications in pediatrics. Its use is safe when administered in pediatric intensive care units under strict monitoring. As a pulmonary vasodilator, nitric oxide has beneficial effects on gas exchange and ventilation. Controlled trials, focusing on early gas administration should be performed under many clinical conditions, especially acute respiratory distress syndrome.J Pediatr (Rio J) 2003;79(Supl.2):S177-S186: Inhaled nitric oxide, pediatrics, pulmonary hypertension, mechanical ventilation. Uso do óxido nítrico em pediatria Inhaled nitric oxide in pediatricsJosé R. Fioretto* IntroduçãoEm 1980, Furchgott e Zawadzki 1 demonstraram que o relaxamento da aorta de coelhos em resposta à acetilcolina era dependente da ...

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Technical considerations for inhaled nitric oxide therapy: time response to nitric oxide dosing changes and formation of nitrogen dioxide

Cited by 17 publications

References 6 publications

Use of nitric oxide inhalation in chronic obstructive pulmonary disease

Use of nitric oxide inhalation in chronic obstructive pulmonary disease

Die Inhalation von Stickstoffmonoxid in der Neonatologie: Stellenwert dieser Therapie im Jahre 2004

Inhaled nitric oxide in pediatrics

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