The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A BENCH STUDY TO DETERMINE THE FEASIBILITY OF USING THE BRONCHTRON HFV WITH THE INOVENT DELIVERY SYSTEM FOR ADMINISTRATION OF NITRIC OXIDE DURING INTER-HOSPITAL TRANSPORT

Tim Macknight1, Kevin Crezee1



Background: Intra-hospital transport of the critically ill infant has seen the expanded use of therapeutics such as high-frequency ventilation and inhaled nitric oxide for referral to the 43 bed NICU at Primary Children's Medical Center in Salt Lake City, Utah. After admission, this HFV/NO patient population occasionally requires additional radiographic studies to better assess their disease process. Hospital-based staff use the Aeronox nitric oxide delivery system (TOFIELD,AB) infrequently, so we sought to evaluate the feasibility of internal transport of these patients utilizing the Bronchtron (Percussionaire, Sandpoint, ID) with the INOvent Nitric Oxide Delivery System (Ikaria, Clinton, NJ).

Methods: Oxygen flows of 10, 5,and 2.5 LPM were delivered to the INOvent injector module and then from the injector module to a green tee adapter placed between the entrainment port and the main ventilator body of the Bronchotron. A sampling line was placed near the ventilator wye and continuously monitored by the INOvent. Nitric Oxide doses of 80, 60, 40, and 20 PPM were set and compared to the delivered dose as measured by the INOvent. O2 flows were delivered by a 100% wall O2 source or from the NO/O2 outlet on the INOvent normally intended for manual ventilation. Ventilator settings selected were a breath rate of 480, good chest "wiggle" on the test lung, and a PAW of either 22 (PSI-40),15 (PSI-35),or 10 (PSI-30). PAW was adjusted upon the addition of additional flow from the injector module to maintain target settings.

Results: Measured nitric oxide ranged from 11-85% of the set dose. Higher O2 flows from the injector module and a lower set PAW on the Bronchotron generally resulted in measured doses closer to the set dose. O2 flows originating from the NO/O2 outlet on the INOvent produced a higher percentage of measured to set nitric oxide dose. Higher O2 flows required some small adjustments in set PAW from the Bronchotron.

Conclusion: Nitric Oxide doses of 20 PPM or less can be consistently delivered using this configuration. Doses greater than 20 PPM require the addition of up to 10 LPM of gas flow into the system. It is imperative that the operator pay close attention to the target PAW and make necessary adjustments.