The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

EVALUATION OF A METHOD FOR DELIVERY OF NITRIC OXIDE THROUGH A PERCUSSIVE HIGH-FREQUENCY INTRA-HOSPITAL TRANSPORT VENTILATOR.

Rick Carter1, Tim Macknight1, Kevin L. Crezee1, Charles J. Hoydu1, Donald M. Null2; 1Respiratory Care Services, Primary Children’s Medical Center, Salt Lake City, UT; 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT

Background: Primary Children’s Medical Center (PCMC) is a 271-bed tertiary care facility located in Salt Lake City, Utah. Annually, PCMC has more than 1200 high-frequency ventilation patient days per year and uses more than 25,000 hours of inhaled Nitric Oxide(iNO). There is a periodic need to move these types of patients within the facility for care not readily available at the bedside. PCMC has acquired a Percussionaire Sinusoidal Bronchotron with Turbohead(Bronchotron) and we seek to test its compatibility with the Ikaria INOMax DS for use in intra-hospital transport. Methods: A Bronchotron is used with a Fisher Paykel RT 130 Infant ventilator circuit. The injector module from the calibrated INOMax DS was placed at the gas outlet from the Bronchotron. The sampling tee was placed 12” back from the patient wye on the inspiratory limb of the ventilator circuit. A 4.5 mm adapter with oxygen tubing was placed at the entrainment port of the Bronchotron and flow ranges of 0-14 LPM were tested. An IMT Medical Infant Smart Lung was used with a resistance setting of 5, compliance setting of 1, and leak setting of 0. Operational pressures on the Bronchotron were tested at 28-40 PSI, with resultant Mean Airway Pressures (PAW) of 10-33 cmH2O. A variety of ventilator settings and iNO doses were tested prior to the addition of external flow to the entrainment port. We then added a flow of 100% oxygen to the entrainment port and tested the effects on the measured iNO dose. Results: Without external flow, measured iNO dose was generally 2x-3x greater than set dose in all testing conditions. We hypothesize that variability in percussive ventilation flow-i.e. “pulsating flow”- diminished the optimal function of injector module. With the addition of an external flow source, discrepancies between set and measured iNO doses decreases. At 14 LPM of external flow, set dose equaled the measured dose across all dose ranges at operational pressures of 28 PSI and was off by 1 to 2 ppm at 40 PSI. However, the added external flow caused the PAW to increase by 2 to 9 cmH2O. The following table shows results of testing with and without external flow to the entrainment port. Conclusions: Measured results show the addition of an external flow of up to 14 LPM prior to placement of the injector module in the circuit suggests iNO can be safely and reliably delivered with the Bronchotron in the intra-hospital transport environment. Sponsored Research - None