NEO - Administration of Gas Mixtures ppt (2/9)

main indication for iNO? What does iNO increase risk of?

>34wk infants w/ hypoxemia resp failure w/ evidence of pulm hypertension

iNO increases risk for intracranial hemorrhage and premies are already at increased risk for it.

Fxn of iNO

Smooth muscle vasodilator relaxing smooth muscle adjacent to fxnal alveoli

Delivery device. Where do you put the attachment to in relation to the humidifier?

Machine placed simultaneously with any other O2 delivery device, being placed on DRY side of humidifier w/ sample port placed PROXIMAL to pt. Flow meter is attached for manual ventilation with iNO

OI equation

OI = (MAP x FiO2 × 100)/PaO2

Indications for iNO? (2)

PaO2 100mmHg on 100% OR OI of 25! Start sooner than later @20ppm! Positive response should happen in 30-60 minutes

Weaning

Wean SLOWLY!!! to lowest amount required

What to check for and how often?

Check every 2h!

1. sample port (can get water in it) as it measures FiO2, NO and NO2 levels

2. NO2 (toxic gas!)

3. Methemoglobin (NO half life is <5s and rapidly binds to Hgb, so if it is too high then NO dose should be weaned)

Heliox fxn

lowers density of gas mixture to allow O2/aerosolized medication to pass through obstruction easier and decrease WoB until more definitive treatments can be effective.

Ratios given for heliox

80:20 w/ flow rate 1.8 or 70:30 (better for UAW obstr. or need increased FiO2) and must be given with a NRB!