Clinical Monitoring of Inhaled Nitric Oxide

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 620-621
Author(s):  
Philip C. Etches ◽  
Neil N. Finer ◽  
Richard A. Ehrenkranz ◽  
Linda L. Wright

Inhaled nitric oxide (NO) is being increasingly utilized for the treatment of pulmonary hypertension and ventilation-perfusion mismatch in association with respiratory failure in adults, children, and neonates.1,2 The three major areas of potential toxicity of NO are the formation of methemoglobin, the production of free radicals such as peroxynitrite, and the formation of nitrogen dioxide (NO2) by reaction with oxygen (O2) in the delivery system. NO2 is toxic,3 with a maximum 8-hour, time-weighted, average exposure recommendation of 5 ppm.4

2003 ◽  
Vol 12 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Mohammed A. Qureshi ◽  
Nipurn J. Shah ◽  
Carol W. Hemmen ◽  
Mary C. Thill ◽  
James A. Kruse

• Background Although low concentrations of inhaled nitric oxide may by therapeutic, both nitric oxide and its oxidation product nitrogen dioxide are potentially toxic. The threshold limits for time-weighted average concentrations of nitric oxide and nitrogen dioxide issued by the American Conference of Governmental Industrial Hygienists are 25 and 3 ppm, respectively. The concentrations of these gases in the breathing space of hospital personnel during administration of nitric oxide to adult patients have not been reported.• Methods Air was sampled from the breathing zone of intensive care unit nurses via collar-mounted tubes during the nurses’ routine duties attending patients who were receiving inhaled nitric oxide at 5 or 20 ppm. The exhaust ports of the mechanical ventilators were left open to the room. Nitric oxide and nitrogen dioxide were chemically assayed as nitrite from sorbent tubes by using spectrophotometry. Ambient nitric oxide levels were measured at sequential distances from the ventilator by using chemiluminescence.• Results The time-weighted average concentrations of inspired gas for nurses during inhaled nitric oxide treatment were 0.45 ppm or less for nitric oxide and less than 0.29 ppm for nitrogen dioxide. Nitric oxide levels at the ventilator during delivery at 20 ppm were 9.2 ppm, but dropped off markedly beyond 0.6 m (2 ft), to a mean of about 30 ppb.• Conclusion Inhaled nitric oxide therapy at doses up to 20 ppm does not appear to pose a risk of excessive occupational exposure to nitric oxide or nitrogen dioxide to nurses during routine delivery of critical care.


2018 ◽  
Vol 46 (6) ◽  
pp. 657-663 ◽  
Author(s):  
Satoshi Suzuki ◽  
Hajime Togari ◽  
Jim L. Potenziano ◽  
Michael D. Schreiber

AbstractObjective:To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA).Materials and methods:iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation.Results:A total of 1,114 neonates were included (n=431, <34 weeks GA; n=675, ≥34 weeks GA; n=8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI<15, 89% vs. 93%; 15≤OI<25, 85% vs. 91%; 25≤OI≤40, 73% vs. 79%; OI>40, 64% vs. 66%).Conclusion:iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.


1996 ◽  
Vol 22 (S1) ◽  
pp. S138-S138
Author(s):  
Gerfried Zobel ◽  
Bernd Urlesberger ◽  
Drago Dacar ◽  
Siegfried Rödl ◽  
Friz Reiterer ◽  
...  

1998 ◽  
Vol 44 (5) ◽  
pp. 814-814
Author(s):  
M T Mazzucchelli ◽  
E Domínguez ◽  
C Cannizzaro ◽  
P Bellani ◽  
C Couceiro

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