The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

THE EFFECTS OF USING A BLENDED GAS SOURCE FOR MANUAL VENTILATION WITH A NITRIC OXIDE DELIVERY SYSTEM

John T. Gallagher1 ,Kathleen M. Deakins1



Introduction:: The manual delivery system of the INOvent Delivery System (Datex-Ohmeda, Madison, WI) is routinely used during manual ventilation for patients receiving INOmax (Ikaria, Clinton, NJ) for inhaled Nitric Oxide (iNO) therapy. The manufacturer of the INOvent suggests using 100% oxygen as the gas source for the manual delivery system. In certain patient populations, such as the premature infant receiving long-term iNO therapy, oxygen (O2) is used judiciously in an effort to prevent Retinopathy of Prematurity and other lung complications (Lloyd, J. Cochrane Database of Systematic Reviews 2003, 2:CD003482). In response to requests to lower the delivered FiO2 of the manual delivery system, we anticipated a change in the molecular composition of the delivered gas when using blended oxygen. The manufacturer of the INOvent specifies that the delivered level of NO will be 20+/-8 ppm when the manual delivery system is sourced with 100% O2 at a flow rate of 15 liters per minute. The purpose of this study is to determine if varying the levels of oxygen in the source gas supplied to the manual delivery system will have an effect on the delivered iNO therapy to the patient.

Methods:
An INOvent was calibrated and setup according to the manufacturer's pre-use instructions. An air/oxygen blender (Bird, Yorba Linda, CA) was used to regulate FiO2 to the input of the manual delivery system. Oxygen supply tubing was attached to the output of the manual delivery system and adapted to accommodate a sample port which was connected by sample tubing to the INOvent digital analyzer. The flow rate was set at 15 liters per minute according to manufacturer's recommendations. Starting at 100%, the Fi02 was reduced in 10% increments as delivered levels of NO, Nitrogen Dioxide (N02), and O2 were measured and recorded from the INOvent gas analyzer.

Results:
The results of measured NO, N02, and O2 levels at various Fi02 are in the table below.

Conclusions:
Based on this bench evaluation, blending an oxygen enriched source gas to the manual delivery system at a set flow rate of 15 liters per minute has no impact on the delivered level of NO and results remain consistent with the manufacturer's specifications.