blood gas analysis

Inhaled Nitric Oxide :

Inhaled Nitric Oxide

What is Nitric Oxide ?:

What is Nitric Oxide ? Nitric Oxide is a highly diffusible, lipid soluble free radical that oxidizes quickly to nitrogen dioxide (NO 2 ) in the presence of oxygen It is produced internally in every cell and organ in the human body.

How iNO works :

How iNO works iNO is a selective pulmonary vasodilator. iNO will dilate only the pulmonary blood vessels adjacent to functioning alveoli. iNO diffuse into the capillaries, free NO immediately binds to hemoglobin forming nitrosylhemoglobin, which is rapidly oxidized to methmoglobin and eventually undergoes conversion to reduced the hemoglobin

Indications for iNO:

Indications for iNO iNO is used to treat pulmonary hypertension such as primary pulmonary hypertenison(PPH) and persistent pulmonary hypertension of newborns (PPHN). Neonates with hypoxic respiratory failure associated pulmonary hypertension. NO therapy is often used with other forms of therapy including high frequency oscillatory ventilation and surfactant therapy, both of which are aimed at improving oxygen delivery and lung compliance.

Dosage :

Dosage Initial dosage was 20 ppm(particles per million). Often reduced to 5 ppm at the end of 4 hours of initial treatment. Reduce inhaled nitric oxide dose by 50% (20, 10,5, 1 ppm).

Methods of administration:

Methods of administration NO is delivered with the O2 at a constant concentration throughout the breathing cycle. Set NO level is stable over a wide range of flows and flow patterns, including spontaneous breathing modes. The flow sensor placed in the outlet of the ventilator upstream from the humidifier measures minute ventilation (lpm).

Method of administration:

Method of administration The injector varied the nitric oxide based on the measured ventilation. Nitric oxide, nitrogen dioxide and oxygen are measured in the inspiratory limb of the circuit, just before the patient wye and a calibration mode verified proper analyzer function. High and low alarms are provided for all three gases and an automatic cut-off to prevent nitric oxide overdose.

Hazards and contraindications:

Hazards and contraindications Nitric oxide when combined with oxygen produces nitrogen dioxide (NO2), which is a toxic gas. Because of it’s very minimal half life (0.1 seconds – 5 seconds), it is quickly inactivated once it combines with hemoglobin. Although rare, the patients as well as health care providers can be adversely affected. Factors influencing NO2 production are O2 concentration, NO concentration and time of contact between NO and O2.

Hazards and contraindications:

Hazards and contraindications Patients most at risk include those receiving high oxygen concentration and low ventilator flow rates. Production of methemoglobin can be a problem due to anemic hypoxia which can be treated with vitamin C.. A major contraindications of this therapy is children who as a result of congenital cardiac anomalies need a right-to-left shunt to survive and NO therapy corrects the right-to-left shunts.