2001 OPEN FORUM Abstracts
NITRICOXIDE WEANING FOR NEONATES
RaymondMalloy BS RRT, Brian Glynn BS RRT, Jay Greenspan MD. Departments of Pulmonary Care and Neonatology, Thomas Jefferson University Hospital,Philadelphia, PA.
BACKGROUND:At Thomas Jefferson University Hospital, the Neonatal Intensive Care Unit?sprotocol for Nitric Oxide (NO) therapy is a newborn with Respiratory DistressSyndrome (RDS) who is > 34 weeks gestation with Persistent Pulmonary Hypertensionof the Newborn (PPHN) and an Oxygen Index (OI) > 15. Infants who meet thiscriterion are treated with NO therapy and the method in which the infant isweaned from this therapy is central to subsequent need for extracorporeal membraneoxygenation (ECMO).
HYPOTHESIS:We hypothesize that weaning patients FI02 first and then weaning the NO at smallincrements (5 parts per million) is appropriate for neonates with PPHN.
Methods:Twenty four patients were studied using the HFOV 3100A to optimize ventilationand oxygenation. NO therapy was started at 20 parts per million (ppm) and FI02was reduced by 2-4% Q30 minutes-Q1 hour as long as the Pa02 was > 80 torrwith Q2-3 hour arterial blood gases and a Sp02 > 94%. Once the FI02 is reducedto 60%, the NO is decreased to 15 ppm and then 10 ppm if the above criterionwere met. The FI02 was then weaned by 2-4% Q1 hour as long as the Pa02 was >80 torr with a Sp02 of > 94%. Once the FI02 was reduced to 40%, the NO wasweaned to 5 ppm and then 2 ppm if the above criterion were met. At 2ppm witha Pa02 > 80 torr and a Sp02> 94%, the decision was made to discontinueNO therapy. The patients were placed on 1 ppm for 30 minutes prior to discontinuationof therapy.
Results:The average time on NO was 52 hours with 75% of the patients studied not requiringECMO and 25% of the patients studied requiring ECMO. The following separatespatients studied by their diagnosis:
1. 14 Meconium AspirationSyndrome (MAS) patients had an average time on NO of 38.6 hours with 93% ofthe patients studied not requiring ECMO and 7% of the patients studied requiringECMO.
2. 6 RDS patients hadan average time on NO of 68 hours with 67% of the patients studied not requiringECMO and 23% of the patients studied requiring ECMO.
3. 4 CDH patients hada average time on NO of 36 hours with 25% of the patients not requiring ECMOand 75% of the patients studied requiring ECMO.
Conclusions: Theaverage time on NO was 52 hours with 75% of the patients not requiring ECMO.We conclude that decreasing FI02 first and then decreasing NO in small incrementsyields positive results for weaning term neonates with PPHN receiving NO. Furtherstudies are being investigated to wean NO within 4 hours from 20 ppm to 5 ppmin increments of 5 ppm and then wean the FI02 to 40% before turning the NO downto 2 ppm.