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
