2012 OPEN FORUM Abstracts
PERIOPERATIVE TRANSPORT AND MONITORING OF THE PATIENT ON INHALED NITRIC OXIDE.
Sherwin E. Morgan1, Philip Verhoef2; 1Respiratory Care, University of Chicago, Chicago, IL; 2Pediatric Anesthesia and Critical Care, University of Chicago, Chicago, IL
BACKGROUND: Inhaled nitric oxide (iNO) has been used for complex cardiac surgery. Studies have indicated that iNO may attenuate intraoperative right heart dysfunction. Post operatively, patients should be transported to intensive care unit (ICU) on iNO, but there has been limited studies proving that the level of iNO delivered and monitored via resuscitation bag during transport is comparable to that provided by commercial ventilator with DS delivery system (CVDS). METHODS: A Mercury®, (Clearwater, Florida) disposable manual resuscitator bag (MB), with a positive end expiratory pressure valve, INOmax DS® (Ikara, Clinton, NJ) (DS) was connected to a test iNO gas cylinder of 800 parts per million (ppm) and attached to a test lung (TL). Two 7 sections of oxygen (O2) tubing was connected to a gas E cylinder containing 100% O2. Two methods for delivery and monitoring of iNO were evaluated. Delivery setup; the O2 tubing was connected to the internal blender (IB) or to the injector module (IM) and gas inlet of the MB. The MB was connected to the TL, the DS was set for 20 ppm and O2 gas flow initiated, allowing comparison of hand ventilation, checking for variation between set and measured iNO. In addition, DS alarms response was evaluated, lines disconnected to test alarm response. The following schematic reflected the experimental monitored method on MB; T1. IB; monitoring via sample tee (Ikara, Clinton, NJ) on gas inlet T2. IM; monitoring via sample tee to gas inlet T3. IB; monitoring sample line to pressure monitor port (PMP) T4. IM; monitoring sample line to PMP, on the top of MB RESULTS: At set flowrate of 10 L/min on the O2 tank, the IB and IM delivery systems performed up to expectations with respect to set iNO to monitored levels iNO, NO2, and FIO2, The results of T1 to T4; iNO-20 ppm, NO2-0.3 ppm and FIO2- 0.99. All alarms responded appropriately for breach of alarm limits. CONCLUSION: We have demonstrated that both iNO delivery and monitoring in a simulation transport system is comparable to that achieved with the CVDS. Gas sampling of iNO and FIO2 is important for detecting alarm conditions. Between May 2006 and May 2012, more than 150 adult patients have been safely transported between operating room and ICU at The University of Chicago Medical Center with the DS and MB. Our results are limited to the MB, additional study is needed to validate other manual resuscitators performance for transport with the DS. Sponsored Research - None MB with sample tee