The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

NITRIC OXIDE ADMINISTRATION VIA AN ANESTHESIA MACHINE BY RESPIRATORY THERAPIST IN THE PICU AND OPERATING ROOM

Shawn Colborn1, Natasha Fencl1, Richard Lin2; 1Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA; 2Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA

Background: Nitric Oxide (NO) administration is an accepted therapy for patients with presumed or known pulmonary hypertension and can be used to help improve oxygenation. Current systems to deliver NO supplied by Ikaria (Clinton, NJ) utilize servo-controlled heated wire pneumotachs to adjust the flow of NO into the breathing gas. These systems were designed to administer NO in a breathing system that is “open”. Use of NO with an anesthesia machine can be more challenging because the breathing system is “semi-closed” and recirculates gas in order to conserve inhalational anesthetics. Delivery of NO into this type of requires technical knowledge about the functionality and interactions of both systems. Methods: To better understand these interactions, we connected an Apollo anesthesia machine to a test lung, a NO delivery system and a source of carbon dioxide to evaluate recirculation in the system. CO2 was bled into the test lung connected to the anesthesia machine and the soda lime was removed to allow CO2 to recirculate. Fresh gas flowrates were increased until the inspiratory CO2 returned to 0 torr. The assumption was made that system was open thus bypasing the rebreathing loop. This test was repeated using the iNOVentĀ® to test the behavior of NO in the system and the efficiency of soda lime. Results: See Table 1 Conclusions: Soda lime is an efficient absorber of CO2 and NO2, but not NO. FGF should exceed the patients minute ventilation or increased until desired inhaled NO concentrations are within desired limits. Low FGFs can create increased NO2 levels and NO levels in excess of 100 ppm causing the iNOVentĀ® delivery system to shutdown. Limitations: We did not test the system using active humidification as it would be utilized in the PICU. Also, since our lung was not gas permeable, the levels of NO and NO2 seen in this model may be higher than what would be seen clinically. Sponsored Research - None

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