DELIVERY AND MONITORING OF INHALED NITRIC-OXIDE IN PATIENTS WITH PULMONARY-HYPERTENSION

Objective: The development of a safe, portable, accurate, and adaptable system to deliver nitric oxide to patients with pulmonary hypertension. Design: A prospective, clinical study. Setting: Tertiary care pediatric intensive care unit and cardiac catheterization laboratory. Patients: One hundred twenty-three patients (median age 11 months, range 1 day to 12 yrs) with pulmonary hypertension who were administered nitric oxide between November 1991 and July 1993. Ninety-one patients were mechanically ventilated (volume-controlled ventilator, n = 53; pressure-controlled ventilator, n = 5; and a pressure-limited, time-cycled infant ventilator, n = 25). The system was adapted to allow high-frequency oscillator (n = 2) or hand ventilation, and for intraoperative use with an anesthesia machine (n = 6). Thirty-two patients were breathing spontaneously through a mask without assistance. Interventions: Nitric oxide was delivered at 10 to 80 parts per million (ppm); the dose was adjusted independently of the Fro, without altering minute ventilation or tidal volume. Measurements and Main Results: Nitrogen dioxide was continuously monitored and exceeded 3 ppm in only four patients. Methemoglobin concentrations were <5% in ah but four patients. Nitric oxide doses remained stable, independent of minute ventilation and could be changed easily and quickly. Conclusions: Inhaled nitric oxide can be administered precisely and reliably through a variety of delivery systems which can be used in patients of any size. Potential toxicity requires careful monitoring and continued improvement on apparatus design.