The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

RELIABLE DELIVERY AND MONITORING OF INHALED NITRIC OXIDE SYSTEM UTILIZING THE VDR-3C PERCUSSIONATOR® HIGH FREQUENCY TRANSPORT VENTILATOR AND THE AERONOX? DELIVERY SYSTEM

Dan Villareal, RRT, and John P. Cleary, MD; Children's Hospital of Orange Co., Orange, CA

Background: The mixing of Nitric Oxide (NO) gas in conventional mechanical ventilation and high frequency oscillatory ventilation has been investigated. However, adequacy of mixing NO in the Percussionator® Phasitron (Sandpoint, ID) with its sliding venturi has not been examined. The purpose of this study was to evaluate the mixing of NO gas utilizing the VDR-3C Percussionator® HFV with the Aeronox? Nitric Oxide Delivery System (Tofield, Alberta, Canada) utilizing a range of clinical ventilatory settings. Secondarily, we compared NO values obtained using the Aeronox? electrochemical (EC) analyzer with a "gold standard" Sievers 280 (Boulder, CO) chemiluminescence (CL) NO analyzer.
Method: The VDR-3C was set-up along with the Aeronox? Delivery System in a manner similar to that utilized during patient transport. A Vent-Aid Training Test Lung (Michigan Instrument) was used to provide 2.5ml/cmH2O/kg static compliance. NO (800ppm) was instilled in the monitoring port of the Phasitron. NO (EC and CL) and NO2 (EC) levels were measured at the following sites: 1) proximal airway monitoring port of the Phasitron; 2) 25cm beyond the instillation port (distal); and 3) port of the test lung. Ventilator settings were as follows: 1) Hz 5, Amp 40, MAP 25; 2) Hz 8, Amp 30, MAP 20; and 3) Hz 15, AMP 20, MAP 15; FiO2 was 1.0. NO was instilled until the desired NO dose of 5ppm, 10ppm, 20ppm, and 40ppm was achieved at the proximal port for each combination of ventilator settings. Both analyzers were calibrated between ventilator and NO changes. NO, NO2 and FiO2 values were recorded 5 minutes after ventilatory changes. Comparisons were made by ANOVA.

Results: NO concentrations were similar at the three sampling ports corresponding with the ventilator changes with a trend of a slight increase in NO value at distal ports. There was negligible difference of NO level readings between the EC and CL analyzer. The table show results using 20ppm NO and analyzed at the proximal and distal airway ports. NO2 levels were below 2.3ppm across the study conditions.

HFV Settings Electrochemical Chemiluminescence
Hz Amp. MAP NO (proximal) NO (distal) NO (proximal) NO (distal)
5 40 25 20 21 20.9 20.9
8 30 20 20 21 20.9 21.5
15 20 15 20 25 21.2 24.8

Conclusion: Reliable delivery of nitric oxide was demonstrated using the Aeronox? Delivery System and the VDR-3C HFV during transport. The levels of NO2 production is well below the level of therapeutic concerns. We have utilized the VDR-3C HFV with INO during transport of >10 patients without complications.

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