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Related Experiment Videos

Ventilatory factors affecting inhaled nitric oxide concentrations during continuous-flow administration

R Fernandez1, A Artigas, L Blanch

  • 1Intensive Care Service, Hospital de Sabadell, Sabadell, Spain.

Journal of Critical Care
|September 1, 1996
PubMed
Summary

Continuous inhaled nitric oxide (NO) delivery near the endotracheal tube is significantly affected by ventilator settings. Adjusting tidal volume, I:E ratio, and dead space alters final NO concentrations in lung models.

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Area of Science:

  • Critical care medicine
  • Pulmonary medicine
  • Biomedical engineering

Background:

  • Inhaled nitric oxide (NO) is used for pulmonary hypertension and hypoxemia in acute respiratory distress syndrome.
  • Optimal delivery site and impact of ventilator settings on NO efficacy remain debated.
  • Understanding these factors is crucial for effective NO therapy.

Purpose of the Study:

  • To investigate the influence of varying ventilator settings on inhaled nitric oxide (NO) concentrations.
  • To determine how tidal volume (Vt), inspiratory-to-expiratory (I:E) ratio, and added dead space affect NO delivery near the endotracheal tube.

Main Methods:

  • Utilized a test lung model ventilated with a ServoVentilator 300.
  • Administered continuous NO flow near the endotracheal tube using a precision flowmeter.

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  • Measured actual NO concentrations via chemiluminescence, analyzing effects of Vt, I:E ratio, and dead space.

    • Main Results:

    • Measured NO concentrations consistently exceeded predicted values across all tested settings.
    • Increasing tidal volume (Vt) showed a dose-dependent increase in NO bias, up to 48% at 300 mL.
    • Altering the I:E ratio and adding dead space significantly amplified NO concentration deviations, with up to 322% increase at a 1:4 I:E ratio with dead space.

    Conclusions:

    • Continuous-flow NO administration near the endotracheal tube is highly sensitive to ventilator settings.
    • Ventilator adjustments, particularly tidal volume and dead space, can substantially alter delivered NO concentrations.
    • These findings highlight the need to consider ventilatory parameters for optimizing inhaled NO therapy.