2000 OPEN FORUM Abstracts
INO, PPHN, and the NICU
Peter Betit, RRT Children's Hospital, Boston, Massachusetts
In December of 1999 the Food and Drug Administration approved the use of inhaled nitric oxide (INO) as an adjunct to mechanical ventilation for neonates diagnosed with persistent pulmonary hypertension of the newborn (PPHN). Several clinical investigations have contributed to this approval, which is being considered a significant milestone in the field of Neonatology. These investigations confirmed that INO is a potent and selective pulmonary vasodilator, and reduces the need for more invasive support in the way of extracorpeal membrane oxygenation (ECMO). INO appears to have few side effects and long-term outcomes appear to be favorable. Respiratory therapists have played an integral role in the execution of these studies, and continue to be the principle clinicians responsible for the technical management of this therapy. It therefore becomes essential for Respiratory Therapists to fully understand the physiology and clinical applications of INO, but more importantly, the limitations and potential hazards.
This lecture will review the physiology and the important clinical investigations associated with INO in the management of PPHN. Clinical criteria for the initiation of INO will be discussed including the importance of echocardiography, lung recruitment, and the recognition of treatment success and failure. Dosing and weaning strategies, including the safe withdrawal of INO will be presented. The formation of methemoglobin and nitrogen dioxide are two safety concerns that will also be addressed. Additionally, the decision to transport patients with INO therapy and the associated technical considerations will also be presented. Data related to pulmonary and neurodevelopment outcomes will be discussed as well as future directions of INO administration in the NICU.