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Occult nitric oxide inhalation improves oxygenation in mechanically ventilated children

Lum, LCS and Tan, PSK and Saville, A and Venkataraman, ST and Pinsky, MR (1998) Occult nitric oxide inhalation improves oxygenation in mechanically ventilated children. Journal of Pediatrics, 133 (5). 613 - 616. ISSN 0022-3476

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Abstract

Objectives: Auto-inhalation of nitric oxide (NO) produced in the upper airways may have physiologic effects on lung function. For intubated patients, the upper airway source of NO is eliminated, but the hospital compressed air source from the environment is contaminated with varying levels of NO, creating an 'occult' form of NO therapy. We examined the physiologic significance of occult inhaled NO in ventilator-dependent pediatric patients. We hypothesized that very low levels of NO contamination in inspired gas improve PaO2 in ventilator-dependent children. Study design: Inspired NO levels at the mouth were measured by chemiluminescence in 4 pediatric subjects with normal lungs and 3 with parenchymal lung disease. Subjects were sequentially ventilated with first standard hospital gas (H1), switched to pure nitrogen-oxygen at a similar FIO2 but with no NO contamination (A2), hospital gas again (H2), the nitrogen-oxygen (A2) to control for time and sequence, and finally the nitrogen-oxygen mixture with supplemental NO in an amount equal to the NO previously measured in hospital gas (A2 + NO). Inhaled NO levels and PaO2 were recorded 15 minutes into each of the 5 steps. Two patients were studied a second time, remote from their first examination. Results: NO levels in inhaled hospital gas mixtures ranged from 13 to 79 ppb (mean H1 = 53.3 ± 23.7 ppb, mean H2 = 53.2 ± 20.7 ppb, mean A2 + NO = 45 ± 15.3 ppb; P < .0001). Removing NO from ventilator gas decreased PaO2 in all subjects, whereas replacing NO in artificial gas restored PaO2 to baseline values (P < .0001). Conclusion: Concentrations of NO in hospital compressed air are variable and have physiologic effects. The long-term implications of these findings remain to be defined.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Lum, LCS
Tan, PSK
Saville, A
Venkataraman, STstv@pitt.eduSTV0000-0002-3260-228X
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 1998
Date Type: Publication
Journal or Publication Title: Journal of Pediatrics
Volume: 133
Number: 5
Page Range: 613 - 616
DOI or Unique Handle: 10.1016/s0022-3476(98)70099-x
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0022-3476
PubMed ID: 9821416
Date Deposited: 13 Mar 2012 15:45
Last Modified: 18 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/11310

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