UK guidelines for the use of inhaled nitric oxide therapy in adult ICUs

Cuthbertson, Brian H.; Dellinger, Phil; Dyar, Oliver James; Evans, TW; Higenbottam, T. W.; Latimer, R.D.; Payen, Didier; Stott, S; Webster, N R; Young, John

doi:10.1007/s001340050488

Cited by 84 publications

(39 citation statements)

References 40 publications

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“…No protocolo que publicamos em 2001 41 , a administração iniciou-se com dose teste de 20 ppm de NOi por 30 minutos e, qualquer que fosse a resposta, a concentração era reduzida para 10 ppm e depois de 30 minutos para 5 ppm, sendo esta dose mantida por mais três horas para completar quatro horas do teste de resposta. Tal cuidado é importante, uma vez que é descrito na literatura que a resposta ao NOi pode manifestar-se apenas após quatro horas 48 A administração segue normas já estabelecidas 41,48 . Resumidamente, uma fração de NOi é continuamente liberada para os pacientes, via fluxômetro, diretamente dentro do ramo inspiratório do circuito do aparelho de ventilação mecânica, distalmente ao umidificador, a 30 cm do tubo endotraqueal.…”

Section: Dose Administração E Retirada Do Tratamento Com Noiunclassified

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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Section: Dose Administração E Retirada Do Tratamento Com Noiunclassified

Inhaled nitric oxide in pediatrics

Fioretto

2003

J Pediatr (Rio J)

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“…It is already understood that the response to iNO is strongly influenced by the application of adequate PEEP 16,47 and, according to recent recommendations, 48 clinical iNO usage for ARDS should be limited to well-ventilated patients with PEEP.…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

“…Such care is important since literature describes that an iNO response may only be manifest after four hours. 48 In the past, patients were maintained on the lowest dose which was associated with a positive response (an increase greater than or equal to 10 mmHg in the PaO 2 /FiO 2 ratio). The maximum dose, in the majority of clinical situations, is 20 ppm to begin the response test.…”

Section: Dose Administration and Withdrawal Of Ino Treatmentmentioning

confidence: 99%

“…49 Administration follows previously established standards. 41,48 In brief, a fraction of iNO is continuously liberated to the patient, via flowmeter, directly into the inspiratory limb of the mechanical ventilation circuit, forward of the humidifier, 30 cm from the endotracheal tube. Concentrations of iNO and of NO 2 (nitrogen dioxide) are continually measured by means of electrochemical sensors or chemoilluminescence of gas samples obtained from as close as possible to the endotracheal tube.…”

Section: Dose Administration and Withdrawal Of Ino Treatmentmentioning

confidence: 99%

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Uso do óxido nítrico em pediatria

Fioretto¹

2003

J. Pediatr. (Rio J.)

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Objective: 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 sideeffects. 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(Suppl 2):S177-S186: Inhaled nitric oxide, pediatrics, pulmonary hypertension, mechanical ventilation.

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“…However, the clinical application of inhaled NOis restricted to shortterm use and requires a delivery system consisting of a closed circuit with a scavenging system. Moreover, the use of inhaled NOrequires monitoring of the concentrations of inhaled and environmental NOand nitrogen dioxide (NO2) because it causes the formation of toxic NO2 (23)(24)(25)(26). Thus, in most cases, inhaled NOhas been used for mechanically ventilated patients but has been considered difficult for awake and ambulatory patients whoneed long-term pulmonary vasodilation therapy to undergo inhaled NOtherapy.…”

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confidence: 99%

Hemodynamic Effects of Inhaled Nitric Oxide Using Pulse Delivery and Continuous Delivery Systems in Pulmonary Hypertension.

et al. 2002

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Objective Inhaled nitric oxide (NO) has been used for pulmonary vasodilation therapy in patients with pulmonary hypertension. Inhaled NOfor awake and ambulatory patients, however, is unusual because it requires intubation or a tightly fitting facemask, and a large-scale delivery systemfor the safe management of toxic nitrogen oxides. Weundertook this study to investigate the possibility of using inhaled NOtherapy for awake and ambulatory patients with pulmonary hypertension.Methods Patients with pulmonary hypertension underwent cardiac catheterization and hemodynamicvariables were measured at the baseline, after inhaled NOusing our pulse delivery system, which involved a nasal cannula and a pulse device, and after inhaled NOusing a continuous delivery system.Patients or materials Westudied seventeen patients with precapillary pulmonary hypertension (4 men and 13 women; age, 41±3, ranging from 19 to 61). Results Cardiac output was increased significantly by each system. Pulmonaryvascular resistance was decreased significantly by each system. There was no significant change in mean pulmonaryartery pressure, mean systemic artery pressure, or systemic vascular resistance. The concentrations of NOand nitrogen dioxide (NO2) in the expiratory gas using the pulse delivery system were 0.0 ppmas long as the pulse device was synchronized with the patient's respiratory cycle. Conclusion Inhaled NOusing our pulse delivery system changed the hemodynamicvariables similarly to those whenusing the continuous delivery system. The concentrations of NOand NO2in the expiratory gas using the pulse delivery system were within safe limits. (Internal Medicine 41 : 429-434, 2002)

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UK guidelines for the use of inhaled nitric oxide therapy in adult ICUs

Abstract: The need for additional quality research to establish evidence of efficacy and safety was emphasized. The guidelines are designed to act within the context of current practice and knowledge and should be revised as further data emerge.

Cited by 84 publications

References 40 publications

Inhaled nitric oxide in pediatrics

Inhaled nitric oxide in pediatrics

Uso do óxido nítrico em pediatria

Hemodynamic Effects of Inhaled Nitric Oxide Using Pulse Delivery and Continuous Delivery Systems in Pulmonary Hypertension.

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