The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Nitric Oxide is Only a Research Tool

Ray Ritz, RRT Wednesday, November 6, 1996

Inhaled nitric oxide (INO) has been the focus of intensive research for over four years and both clinical and laboratory studies have demonstrated the effectiveness of INO in the treatment of hypoxemia and pulmonary hypertension. Although INO is currently classified as an experimental drug by the FDA, with holding this therapy from those patients who may benefit from its use borders on unethical.

The administration of specialty gases such as heliox, carbon dioxide, as well as other anesthetic agents has paved the wave for the use of INO. Currently available gas administration devices easily accommodate the delivery of INO in a variety of adult and pediatric ventilators. In continuous flow pediatric ventilators, the addition of INO is accomplished with a simple flow meter. With non-constant flow ventilators, a simple gas blender and several appropriately configured high pressure hoses are all that is required to include INO in the inspiratory gas. The only specialty devices required for INO administration are the correct cylinder regulator and an electrochemical NO/NO_{2} analyzer. Electrochemical NO/NO_{2} analyzers require calibration with known levels of NO and NO_{2} but otherwise operate similarly to common O_{2} analyzers.

Low concentrations of INO - between 5 and 20 ppm - are environmentally safe and present little risk to the patient. The risks of methemoglbin anemia and inadvertent exposure to NO_{2} are usually associated with higher doses of INO. There are other complications which may be associated with INO but this is true for many other drugs. Institutions choosing to administer INO must evaluate each potential recipient for the presence of left heart failure and bleeding disorders. Not every patient should have INO but those who may benefit from it and who are not at risk for some of the above complications should receive it.

The administration of INO is not rocket science. Inappropriately applied PEEP or over distention of the lung may pose a greater risk to the patient than low dose INO. Hospitals who chose to make INO available must develop an organized protocol for its application but they should not be excluded from offering it to their patients because they are not doing research.

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