A study of mixing conditions during nitric oxide administration using simultaneous fast response chemiluminescence...

We have evaluated the mixing properties of nitric oxide in inspired gases for five different administration techniques. Nitric oxide and carbon dioxide were delivered to the ventilator system before the ventilator or after the ventilator as a continuous flow, either directly into the inspiratory limb or into a mixing chamber positioned in the inspiratory limb. Both gases were delivered as above but synchronized with inspiration. Mixing conditions were evaluated using fast response chemiluminescence for nitric oxide and capnography for carbon dioxide analysis. Administration of nitric oxide and carbon dioxide directly into the inspiratory limb as a continuous flow or with a magnetic valve-controlled synchronized flow resulted in peak concentrations of 236% and 220%, respectively, of expected values. The use of a mixing chamber reduced these values to 104% and 102%, respectively. Administration of nitric oxide as a continuous flow into the tubing of an intermittent flow ventilator resulted in highly fluctuating inspiratory peak concentrations, which could be avoided with a mixing chamber.