In Vitro Validation and Characterization of Pulsed Inhaled Nitric Oxide Administration During Early Inspiration

Overview

Journal J Clin Monit Comput

Publisher Springer

Specialties Anesthesiology
General Medicine
Medical Informatics

Date 2021 Mar 18

PMID 33735405

Citations 1

Authors

Philipp A Pickerodt

Moritz B T Hofferberth

Thilo Busch

Martin Russ

Mahdi Taher

Willehad Boemke

Steffen Weber-Carstens

Rainer Kobrich

Erik Swenson

Maria Deja

Roland C E Francis

Affiliations

Soon will be listed here.

Abstract

Purpose: Admixture of nitric oxide (NO) to the gas inspired with mechanical ventilation can be achieved through continuous, timed, or pulsed injection of NO into the inspiratory limb. The dose and timing of NO injection govern the inspired and intrapulmonary effect site concentrations achieved with different administration modes. Here we test the effectiveness and target reliability of a new mode injecting pulsed NO boluses exclusively during early inspiration.

Methods: An in vitro lung model was operated under various ventilator settings. Admixture of NO through injection into the inspiratory limb was timed either (i) selectively during early inspiration ("pulsed delivery"), or as customary, (ii) during inspiratory time or (iii) the entire respiratory cycle. Set NO target concentrations of 5-40 parts per million (ppm) were tested for agreement with the yield NO concentrations measured at various sites in the inspiratory limb, to assess the effectiveness of these NO administration modes.

Results: Pulsed delivery produced inspiratory NO concentrations comparable with those of customary modes of NO administration. At low (450 ml) and ultra-low (230 ml) tidal volumes, pulsed delivery yielded better agreement of the set target (up to 40 ppm) and inspiratory NO concentrations as compared to customary modes. Pulsed delivery with NO injection close to the artificial lung yielded higher intrapulmonary NO concentrations than with NO injection close to the ventilator. The maximum inspiratory NO concentration observed in the trachea (68 ± 30 ppm) occurred with pulsed delivery at a set target of 40 ppm.

Conclusion: Pulsed early inspiratory phase NO injection is as effective as continuous or non-selective admixture of NO to inspired gas and may confer improved target reliability, especially at low, lung protective tidal volumes.

Citing Articles

Modes of administration of nitric oxide devices and ventilators flow-by impact the delivery of pre-determined concentrations.

Vuillermoz A, Lefranc M, Prouvez N, Brault C, Zerbib Y, Schmitt M Ann Intensive Care. 2024; 14(1):130.

PMID: 39167232 PMC: 11339004. DOI: 10.1186/s13613-024-01351-w.

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