Inaccuracies of nitric oxide delivery systems during adult mechanical ventilation

被引:45
作者
Imanaka, H
Hess, D
Kirmse, M
Bigatello, LM
Kacmarek, RM
Steudel, W
Hurford, WE
机构
[1] MASSACHUSETTS GEN HOSP, BOSTON, MA 02114 USA
[2] HARVARD UNIV, SCH MED, DEPT ANAESTHESIA, CAMBRIDGE, MA 02138 USA
关键词
gases; chemiluminescence; nitric oxide; ventilation; mechanical;
D O I
10.1097/00000542-199703000-00021
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Various systems to administer inhaled nitric oxide (NO) have been used in patients and experimental animals. We used a lung model to evaluate five NO delivery systems during mechanical ventilation with various ventilatory patterns. Methods: An adult mechanical ventilator was attached to a test lung configured to separate inspired and expired gases. Four injection systems were evaluated with NO injected either into the inspiratory circuit 90 cm proximal to the Y piece or directly at the Y piece and delivered either continuously or only during the inspiratory phase. Alternatively, NO was mixed with air using a blender and delivered to the high-pressure air inlet of the ventilator. Nitric oxide concentration was measured from the inspiratory limb of the ventilator circuit and the tracheal level using rapid and slow-response chemiluminescence analyzers. The ventilator was set for constant-flow volume control ventilation, pressure control ventilation, pressure support ventilation, or synchronized intermittent mandatory ventilation. Tidal volumes of 0.5 l and 1 l were evaluated with inspiratory times of 1 s and 2 s. Results: The system that premixed NO proximal to the ventilator was the only one that maintained constant NO delivery regardless of ventilatory pattern. The other systems delivered variable NO concentration during pressure control ventilation and spontaneous breathing modes. Systems that injected a continuous flow of NO delivered peak NO concentrations greater than the calculated dose. These variations were not apparent when a slow-response chemiluminescence analyzer was used. Conclusions: NO delivery systems that inject NO at a constant rate, either continuously or during inspiration only, into the inspiratory limb of the ventilator circuit produce highly variable and unpredictable NO delivery when inspiratory flow is not constant. Such systems may deliver a very high NO concentration to the lungs, which is not accurately reflected by measurements performed with slow-response analyzers.
引用
收藏
页码:676 / 688
页数:13
相关论文
共 44 条
[1]   ACUTE EFFECTS OF INHALED NITRIC-OXIDE IN CHILDREN WITH SEVERE HYPOXEMIC RESPIRATORY-FAILURE [J].
ABMAN, SH ;
GRIEBEL, JL ;
PARKER, DK ;
SCHMIDT, JM ;
SWANTON, D ;
KINSELLA, JP .
JOURNAL OF PEDIATRICS, 1994, 124 (06) :881-888
[2]   CONTINUOUS IN-LINE NEBULIZERS COMPLICATE PRESSURE SUPPORT VENTILATION [J].
BEATY, CD ;
RITZ, RH ;
BENSON, MS .
CHEST, 1989, 96 (06) :1360-1363
[3]   INHALED NITRIC-OXIDE LOWERS PULMONARY CAPILLARY-PRESSURE AND CHANGES LONGITUDINAL DISTRIBUTION OF PULMONARY VASCULAR-RESISTANCE IN PATIENTS WITH ACUTE LUNG INJURY [J].
BENZING, A ;
GEIGER, K .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1994, 38 (07) :640-645
[4]  
Betit P, 1995, RESPIR CARE, V40, P706
[5]   PROLONGED INHALATION OF LOW CONCENTRATIONS OF NITRIC-OXIDE IN PATIENTS WITH SEVERE ADULT-RESPIRATORY-DISTRESS-SYNDROME - EFFECTS ON PULMONARY HEMODYNAMICS AND OXYGENATION [J].
BIGATELLO, LM ;
HURFORD, WE ;
KACMAREK, RM ;
ROBERTS, JD ;
ZAPOL, WM .
ANESTHESIOLOGY, 1994, 80 (04) :761-770
[6]   ENHANCED PNEUMONIA RESOLUTION BY INHALATION OF NITRIC-OXIDE [J].
BLOMQVIST, H ;
WICKERTS, CJ ;
ANDREEN, M ;
ULLBERG, U ;
ORTQVIST, A ;
FROSTELL, C .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1993, 37 (01) :110-114
[7]   Nitric oxide: Delivery, measurement, and clinical application [J].
Body, SC ;
Hartigan, PM ;
Shernan, SK ;
Formanek, V ;
Hurford, WE .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1995, 9 (06) :748-763
[8]   INHALED NITRIC-OXIDE REVERSES HYPOXIC PULMONARY VASOCONSTRICTION IN DOGS - A PRACTICAL NITRIC-OXIDE DELIVERY AND MONITORING-SYSTEM [J].
CHANNICK, RN ;
NEWHART, JW ;
JOHNSON, FW ;
MOSER, KM .
CHEST, 1994, 105 (06) :1842-1847
[9]   Inhaled nitric oxide in children with severe lung disease: Results of acute and prolonged therapy with two concentrations [J].
Day, RW ;
Guarin, M ;
Lynch, JM ;
Vernon, DD ;
Dean, JM .
CRITICAL CARE MEDICINE, 1996, 24 (02) :215-221
[10]   EFFECT OF INHALED NITRIC-OXIDE ON RIGHT-VENTRICULAR FUNCTION IN ADULT-RESPIRATORY-DISTRESS-SYNDROME [J].
FIEROBE, L ;
BRUNET, F ;
DHAINAUT, JF ;
MONCHI, M ;
BELGHITH, M ;
MIRA, JP ;
DALLAVASANTUCCI, J ;
DINHXUAN, AT .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 151 (05) :1414-1419