The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts


Raymond Malloy BS, RRT, Brian Glynn BS RRT, William Bucher RRT, Caroline Devereux BS, Jay Greenspan MD; Thomas Jefferson University Hospital, Philadelphia, PA

BACKGROUND: At Thomas Jefferson University Hospital, the Neonatal Intensive Care Nursery's protocol for Nitric Oxide (NO) therapy is a newborn with Respiratory Distress Syndrome (RDS) who is >34 weeks gestational age with Persistent Pulmonary Hypertension of the Newborn (PPHN) and an Oxygen Index (OI) of>15 but <25. Infants who meet these criterion are treated with NO therapy and the method in which the infant is weaned from this therapy is central to subsequent need for ECMO (extracorporeal membrane oxygenation). HYPOTHESIS: We hypothesize that weaning patients on NO every eight hours: 20-10-5 parts per million (ppm) is appropriate. After 24 hours, if the OI is >15, the NO therapy is restarted at 5ppm and a trial period where the infant is completely off of the NO therapy is attempted every 24 hours. After this period a measured OI of 15 is used to determine the successfulness of the weaning.

Nine patients were studied using the HFOV 3100A to optimize ventilation and oxygenation. NO therapy was started at 20ppm and reduced by 50% every 8 hours. Our results were as follows:

PATIENT DIAGNOSIS Hours of Nitric Oxide Received Need for ECMO
1 Meconium Aspiration (MAS) 12h YES
2 RDS; Gastroschesis 24h NO
3 MAS 120h YES
4 MAS 4h YES
5 MAS 3h YES
6 Left CDH 63h YES
7 Right CDH 45h YES
9 RDS; pneumonia 9.5h YES

Conclusions: The average time on NO therapy was 30.3 hours with 78% requiring ECMO, 11% not requiring ECMO, and 11% deceased. We conclude that weaning NO therapy every 8 hours by 50% is too aggressive. Further studies are being investigated to wean NO at a slower rate (5ppm increments) after the FiO2 is <60%.
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