The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

EVALUATION OF PLACEMENT OF NITRIC OXIDE SAMPLING LINE IN INFANT VENTILATOR CIRCUIT DURING SIMULTANEOUS DELIVERY WITH A CONTINUOUS NEBULIZER.

Rick Amato, James Johnson, Cynthia White; Respiratory Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Background: We have been using continuous inhaled Epoprostenol (Flolan®) in our NICU for several years to treat pulmonary hypertension in infants with Congenital Diaphragmatic Hernia and other conditions. Often inhaled Nitric Oxide (iNO) is also simultaneously administered to these patients. This has cause problems with medication and condensation entering the iNO sampling port resulting in clogging problems in the INOmax DSIR™ unit despite attempts to try placing filters and change the sampling line more frequently. A solution was to place sampling line prior to medication delivery to avoid nebulization into the sampling line. For our practice, this meant measuring iNO delivery prior to the aerogen solo nebulizer placed on the dry side of the heater in the inspiratory limb of the infant ventilator circuit. To validate this practice, we set up a bench study to test they hypothesis that there was no difference in iNO measurement at this site compared to the recommended placement site of the sampling line in the infant ventilator circuit Methods: A Servo i ventilator was calibrated according to manufacturer’s recommendations using an infant Evaqua circuit and connected to a TTL lung model 560li (Michigan Instruments, Grand Rapids, MI). An INOmax DSIR™ unit(Ikaria, Madison, WI), was calibrated according to manufacturer’s recommendations. iNO was set at 20ppm and the sampling port was placed at three different positions within the inspiratory limb of the infant ventilator circuit. Position one was located in the inspiratory limb at the patient wye. Position two was at the recommended measurement of iNO after the extension piece in the inspiratory limb. Position three was located prior to the aerogen solo nebulizer placement on the dry side of the humidifier. We allowed gas delivery to stabilize at each position for 5 minutes to record iNO readings. Results: Measurements were as follows: position one (wye) -20ppm, position two (after extension piece)- 20ppm, position three (prior to humidifier)-18ppm Discussion: There was no difference in Nitric Oxide delivery with or without the inspiratory limb extension tubing in place in the infant ventilator circuit. iNO delivery was 2ppm lower measured prior to the humidifier, but is within an acceptable range. We feel measurement at this site is superior to intermittent measurement or complications with nebulization into the sampling line and INOmax DSIR™ unit Sponsored Research - None