2001 OPEN FORUM Abstracts
ONE-YEAREXPERIENCE WITH NITRIC OXIDE FOR INTERHOSPITAL TRANSPORT DURING NEONATAL MECHANICALVENTILATION
Michael Tracy RRT,Susan Izatt MD, Eileen Stork MD, RobertChatburn RRT, FAARC Rainbow Babies & Children?s Hospital/Case Western ReserveUniversity, Cleveland, Ohio
INTRODUCTION Newbornswith respiratory failure complicated by persistent pulmonary hypertension (PPHN)of the neonate are frequently transported to our hospital for continued medicalmanagement and possible ECMO. We previously described [Respir Care 1998;43(10):832]a portable nitric oxide delivery system (PrinterNox, Micromedical) for use withour transport ventilator (Biomed MVP-10) to provide inhaled nitric oxide (iNO)to ventilated neonates during interhospital transport. We describe one year?sexperience with this system.
METHODS Termand near term infants (>34 weeks gestation) with respiratory failure wereidentified at the time of referral. Patients <34 weeks gestation were notenrolled. The transport team consisted of a respiratory therapist, a physician(attending or fellow), and a nurse. Consent was obtained for iNO if the oxygenindex (OI = mean airway pressure x FIO2 x 100 / PaO2)was greater than 40 after optimized medical & ventilator management at thereferral center. Patients with an OI = 40, who were medically stable, were transportedwithout iNO. Patients who had an OI = 40, who were not medically stable, wereeligible to receive iNO at the discretion of the transport attending neonatologist.Patients were then followed in the NICU for outcome and adverse side effectsof iNO therapy.
RESULTS In year2000, 7% (21/296) of transported infants with respiratory failure were identifiedas potential candidates for iNO during interhospital transport (mean OI = 40.1median =36). 90% (19/21) had a diagnosis of primary pphn or pulmonary hypertensionassociated with identified lung disease such as meconium aspiration syndromeor pulmonary hypoplasia. 38% (8/21) qualified for iNO during transport (meanOI = 58.5). Seven of 8 responded to iNO. The mean saturation increased from65% to 92% (mean increase in sat. = 27%, median 30%). Two of 8 eventually wenton ECMO (mean OI = 67). An additional 8 who did not qualify for transport iNOeventually qualified for iNO treatment (mean OI = 31, median OI = 34). Fiveof 21 (23.8%) were managed with medical and ventilatory management alone (meanOI = 26.2). There were no mechanical problems reported with the transport deliverysystem. There were no adverse effects reported from the use of NO in these patients.Six of 21 patients (29%) later expired or had support withdrawn (mean OI= 42.7).Two had birth asphyxia, one had Vein of Galen malformation, one had homozygousachrondroplasia and two had pulmonary hypoplasia. Two of the 6 had receivediNO on transport (mean OI = 71). No patient expired during transport or duringthe first 72 hours following transport.
CONCLUSIONS Selectiveuse of iNO to improve oxygenation in the sickest neonates with respiratory failure(OI>40) enhances respiratory stability during transport and may save lives.This series provides compelling evidence that iNO has a place in the neonataltransport armamentarium.