The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

EVALUATION OF THE EFFECTS OF IN-LINE INTRAPULMONARY PERCUSSIVE VENTILATION ON DELIVERED INHALED NITRIC OXIDE DURING MECHANICAL VENTILATION.

Nancy Johnson, Kathleen Deakins, Timothy Myers; Pediatric Respiratory Care, UHHS RBC Case, Cleveland, OH

Introduction: Intrapulmonary Percussive Ventilation (IPV) (Percussionaire, Sandpoint ID) is often utilized for airway clearance or hyperinflation for atelectasis on intubated mechanically ventilated patients. At Rainbow Babies & ChildrenÂ’s, IPV is typically delivered in-line when the need for inhaled Nitric Oxide (iNO) or substantial ventilator support is required. The purpose of this study was to determine if in-line IPV treatment has an undesired effect on delivered iNO concentrations. Methods: A Draeger XL ventilator (Draeger Medical, Telford, PA) equipped with an Airlife Pediatric circuit (Carefusion, Yorba Linda CA) on the following simulated settings: pediatric mode at PCV +, PIP 30, PEEP +10, rate 30, Pressure support 5, FIO2 30% was attached to a BC Biomedical Infant Smart Lung (BC Biomed, St. Louis MO) set with compliance at 5 ml/mbar and a resistance 5 L/sec. An IPV breathing circuit assembly was connected to the inspiratory limb of the ventilator circuit with a T adapter. The iNOmax DS ir (Ikaria: Hampton NJ) flow injector was placed in-line the ventilator circuit and set at NO levels: (10, 20, 40 and 80 ppm) As iNO levels stabilized, measured values were recorded from the sample line five inches from the patient wye on the inspiratory limb. IPV was then introduced and cycled at the following settings; pressure 20 cm H20, frequency 220/bpm for a period of one minute. iNO concentration measurement was repeated after introducing IPV. The difference in measured iNO values were compared with and without IPV running in line with the ventilator. Results: The analyzed results from the iNOmaxDS ir are listed below: Conclusion: For mechanically ventilated patients that require iNO, when introducing IPV for clinical conditions, clinicians need to be aware that iNO concentration delivered is 10 % of the desired level. Sponsored Research - None Analyzed NO Results pre/post IPV