The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

NITRIC OXIDE DELIVERY IN MRI USING AN ADAPTED INOMAX®DSIR SYSTEM.

Donna K. Parker1, Claire Skold2, Katherine Bushur2; 1Respiratory Care, Children’s Hospital Colorado, Aurora, CO; 2Radiology Department, Children’s Hospital Colorado, Aurora, CO

Background: Inhaled Nitric Oxide (iNO) is a potent pulmonary vasodilator FDA approved for use in term or near term neonates with hypoxemic respiratory failure. It is also widely used for various off label applications. The INOmax®DSIR (Ikaria) is the standard device for iNO delivery and has not been cleared for use in MRI. MRI utilizes a strong magnetic field which poses a safety risk as metal objects are attracted to the magnet and may be pulled into the scanner at high rates of speed. MRI may interfere with function of medical equipment and electronic equipment may create artifact affecting the quality of images.Method: The complete INOmaxDSIR system was scanned for ferrous metal content which was found in components of the stand as well as the INOmax® cylinder cap. Both the INOmaxDSIR & INOblender® were removed from the stand and secured on a MRI safe stand. The cylinder cap with ring was removed from the cylinder and the regulator attached outside the MRI suite. Following preuse check, the system was rescanned for ferrous metal content before being moved into the MRI room and placed behind the guass line. The Injector module and sample line were placed in line with the SERVO-I MRI safe ventilator (Marguet) utilizing standard ventilator circuits. A test lung was attached to the wye. The DSIR contains a 6 hour battery so was not connected to AC power to prevent artifact in MRI images. Standard brain MRIs were run on a Siemens Avanto 1.5 Tesla scanner. Ventilator parameters and imaging was varied to mimic neonatal, pediatric, & adult patients. NO dose was adjusted to 5, 10, 20, & 40ppm. All alarms were set at standard levels. The INOmax DSIR system and SERVO-i were monitored for delivery accuracy, along with function of alarms, monitors, and infrared device. MRI images were monitored for artifact. The INOblender was also tested at doses of 5, 10, 15, 20, 30, & 40ppm.Results: Artifact was not noted on the MRI images. The INOmaxDSIR & INOblender functioned within specifications (no variability) at all NO doses and ventilator settings. No variances in alarm function, monitoring, or infrared system were noted on the INOmaxDSIR.Conclusions: The INOmaxDSIR & INOblender were deemed MRI conditional at our institution when placed on a MRI safe stand with removal of ferrous metal components. This system has been used successfully on patients undergoing cardiac, brain, & neck MRIs without issues. Additional testing is required for use with systems >1.5 Tesla. Sponsored Research - None