The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

UTILIZATION OF INO WHEN USING A NOVEL VENTILATOR CIRCUIT CONNECTOR UNDER SIMULATED NEONATAL MECHANICAL VENTILATION CONDITIONS – AN IN VITRO STUDY.

Krzysztof Chmura2, Chris Henderson1, Timothy J. Gregory1, Martin Keszler3, Janusz Gadzinowski2, Jan Mazela1,2; 1Preclinical, Discovery Laboratories, Inc., Warrington, PA; 2Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland; 3Department of Neonatology, Brown University, Women and Infants Hospital, Providence, RI

Background: Inhaled nitric oxide (iNO) is a standard treatment for persistent pulmonary hypertension of the newborn (PPHN). The standard of care (SoC) for iNO delivery is to introduce the gas into the inspiratory limb of the ventilator circuit, leading to potential gas loss and environmental contamination. We hypothesize that the use of a novel ventilator circuit (VC) connector (Afectair®, Discovery Laboratories, Inc., Warrington, PA) will result in a substantial reduction of NO utilization during simulated neonatal ventilatory conditions. Aim: The aim of the study was to determine iNO utilization when targeting an iNO concentration of 20 ppm using the VC connector vs. control (SoC) under robust in vitro ventilation conditions that simulate neonatal clinical conditions. Methods: A neonatal system was assembled utilizing a ventilator, test lung and lung simulator. The ventilator was used in pressure control mode with a rate of 55 bpm and inspiratory pressures of 20, 30, 40 cmH2O and CPAP of 5 cmH2O. For SoC, using a wye connector, the iNO was delivered from the NO flow controller into the ventilator circuit. With the VC connector, iNO was administered via a non-corrugated tube attached directly to the VC connector. NO concentrations were measured with a NOxBOX®+ analyzer (Bedfont Scientific, Kent, United Kingdom) and iNO flow was titrated to achieve a concentration of 20 ppm delivered at the patient interface for both delivery systems. All measurements were done in triplicate. Results: NO utilization was 33%-69% lower using the VC connector compared with SoC (p < 0.05) [Figure 1: NO flow at a targeted iNO concentration of 20 ppm under simulated neonatal ventilatory conditions]. Conclusions: Delivery of iNO through the VC connector allowed for less utilization of NO to achieve targeted delivery of 20 ppm. These results suggest that clinical use of this VC connector to deliver iNO may reduce NO consumption during treatment of PPHN. Further assessment of the economic impact of reduced NO consumption when using the VC connector is warranted. Sponsored Research - Poznan University of Medical Sciences, Poznan, Poland provided financial support. Discovery Laboratories, Inc. provided Afectair connectors.