The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

THE EFFECT OF CHANGING FLOW RATES ON INHALED NO, NO2 and FiO2 CONCENTRATIONS USING THE MANUAL VENTILATION SYSTEM ON THE DATEX/OHMEDA INOvent®

Sandra R. Wadlinger, BA, RRT, CPFT, Lorraine F. Hough, MEd, RRT, CPFT; The Children's Hospital of Philadelphia, Philadelphia, PA

Background: The use of the Datex/Ohmeda INOvent delivery system for inhaled Nitric Oxide (NO) therapy has become a standard in our large pediatric institution. We were not satisfied with the manufacturer's suggested options when hand ventilation was required. We set up a second tank of nitric oxide with a regulator and flowmeter for use with a flow inflating manual resuscitator bag in order to more closely mimic both the FiO2 and NO concentration our patients were receiving on the mechanical ventilator. However, this system relied on the accuracy of the oxygen flowmeter used to titrate the NO, the bleeding of gas before connecting the patient to avoid high nitrogen dioxide (NO2) levels, the memory of the caregivers to turn the tank off after use and the expense of a stainless steel tank regulator and stand-alone nitric oxide tank at the bedside. We found this system awkward but functional. This evaluation investigates the stability and concentrations of NO, NO2 and FiO2 delivered via a flow inflating manual resuscitator bag while varying flow rates on the INOvent manual delivery system.
Methods and Materials: Oxygen flow was titrated utilizing an Ohmeda pressure compensated oxygen flowmeter attached to a 50 psi wall oxygen outlet. The output from the flowmeter was attached to the O2 inlet port on the back of the INOvent using an O2 high pressure supply hose. Oxygen tubing was attached to the NO/O2 outlet on the back of the INOvent and used to supply gas to a flow inflating manual resuscitator bag (Vital Signs Babysafe? [one-half] L). A sample tee was placed in line with the constant flow proximal to the adapter on the manual resuscitator bag. Gas was sampled with inspiratory sample line tubing attached to the connector on the front of the INOvent. NO, NO2 and O2 measurements were obtained at 15 lpm, 12 lpm, 10 lpm and 8 lpm. This test was repeated on four different INOvent delivery systems to assure reproducibility.

Results: Readings obtained are contained in the chart below:

Machine 1 Machine 2 Machine 3 Machine 4 Average
FLOW O2 NO2 NO O2 NO2 NO O2 NO2 NO O2 NO2 NO O2 NO2 NO
15 lpm 99.0 0.2 18.0 98.0 0.4 18.0 96.0 0.3 20.0 98.0 0.5 19.0 97.8 0.4 18.8
12 lpm 99.0 0.2 15.0 98.0 0.2 15.0 97.0 0.1 16.0 98.0 0.5 15.0 98.0 0.3 15.3
10 lpm 100.0 0.1 12.0 99.0 0.1 13.0 97.0 0.1 14.0 99.0 0.5 13.5 98.8 0.2
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