The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

EVALUATION OF NITRIC OXIDE DELIVERY THROUGH AN INFANT HEATED HUMIDIFIED HIGH FLOW NASAL CANNULA

Rick Carter, Kevin Crezee, Paul Stanley; Respiratory, Primary ChildrensMedical Center, Salt Lake City, UT

Background:Primary Childrens Medical Center (PCMC) has historically has used Nitric Oxide with nasal cannula in our neonatal population. In many of those patients there was a large variance between set and delivered nitric oxide at flows of 1 lpm to 1.5 lpm. It was determined that a method of consistent delivery was needed. Method: A Fisher & Paykel (F&P) Heated Humidified High Flow (HHHFNC)system consisting of a MR850 heater, RT329 circuit, and various sizes of High Flow Nasal Cannulas. We used HHHFNC due to the flows we were testing for the < 5kg Neonate and infant populations. In clinical practice at PCMC, flows greater than 1.5 lpm are delivered with a HHHFNC. The F&P infant HHHFNC system has a functional flow range of .3 lpm to 10 lpm per the manufacturer. For testing purposes we used flows from 1 lpm to 6 lpm and Nitric Oxide(NO) doses ranging from 1 ppm to 20 ppm to evaluate consistency between set and delivered NO. A calibrated INO vent DS unit was adapted to deliver and sample NO in the HHHFNC system as per manufacturers recommendations. Results: The HHHFNC was set up with temperature at 37 degrees celsius on F&P MR850 heater. The testing consisted of different flows, set set / delivered nitric amounts, and cannula sizes recorded in the following table. HHHFNC input manifold pressures were also measured using a Dynatech 207B digital pressure meter. The measured pressures did not exceed the INO Vent DS manufacturer recommendations. Set FIO2 was 100% for testing all tested NO doses and HFNC variations. Conclusions:We found that the largest discrepancies between set and delivered NO were between 1 and 2 lpm, and 1 and 2 ppm of NO. The data showed 2 lpm on 1 ppm of NO was the most accurate. All other flows and NO doses delivered were comparable for accuracy between set and delivered. As a result of this data our institution no longer delivers NO at flows lower than 2 lpm. Sponsored Research - None

INO DS / Liter Per Minute Flow Chart

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