Generation of nitrogen dioxide during nitric oxide therapy and mechanical ventilation of children with a Servo 900C ventilator

1997 ◽  
Vol 23 (4) ◽  
pp. 450-455 ◽  
Author(s):  
M. Losa ◽  
J. Tibballs ◽  
B. Carter ◽  
M. P. Holt
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Nitrogen Dioxide ◽  
Nitric Oxide Therapy

Technical considerations for inhaled nitric oxide therapy: time response to nitric oxide dosing changes and formation of nitrogen dioxide

1997 ◽  
Vol 156 (6) ◽  
pp. 460-462 ◽  
Author(s):  
J. Breuer ◽  
F. Waidelich ◽  
C. Irtel von Brenndorff ◽  
L. Sieverding ◽  
W. Rosendahl ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Nitrogen Dioxide ◽  
Inhaled Nitric Oxide ◽  
Time Response ◽  
Nitric Oxide Therapy ◽  
Technical Considerations

Nitrogen Dioxide Production during Mechanical Ventilation with Nitric Oxide in Adults 

1995 ◽  
Vol 82 (5) ◽  
pp. 1246-1254 ◽  
Author(s):  
Masaji Nishimura ◽  
Dean Hess ◽  
Robert M. Kacmarek ◽  
Ray Ritz ◽  
William E. Hurford
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Nitrogen Dioxide ◽  
Residence Time ◽  
Rate Constants ◽  
Minute Ventilation ◽  
Test Lung ◽  
Mechanical Ventilators ◽  
Lung Volumes ◽  
Air Inlet

Background Inhaled nitric oxide (NO) may be useful in the treatment of adult respiratory distress syndrome and other diseases characterized by pulmonary hypertension and hypoxemia. NO is rapidly converted to nitrogen dioxide (NO2) in oxygen (O2) environments. We hypothesized that in patients whose lungs are mechanically ventilated and in those with a long residence time for NO in the lungs, a clinically important [NO2] may be present. We therefore determined the rate constants for NO conversion in adult mechanical ventilators and in a test lung simulating prolonged intrapulmonary residence of NO. Methods NO (800 ppm) was blended with nitrogen (N2), delivered to the high-pressure air inlet of a Puritan-Bennett 7200ae or Siemens Servo 900C ventilator, and used to ventilate a test lung. The ventilator settings were varied: minute ventilation (VE) from 5 to 25 l/min, inspired O2 fraction (FIO2) from 0.24 to 0.87, and [NO] from 10 to 80 ppm. The experiment was then repeated with air instead of N2 as the dilution gas. The effect of pulmonary residence time on NO2 production was examined at test lung volumes of 0.5-4.0 l, VE of 5-25 l/min, FIO2 of 0.24-0.87, and [NO] of 10-80 ppm. The inspiratory gas mixture was sampled 20 cm from the Y-piece and from within the test lung. NO and NO2 were measured by chemiluminescence. The rate constant (k) for the conversion of NO to NO2 was determined from the relation 1/[NO]t-1/[NO]o = k x [O2] x t, where t = residence time. Results No NO2 was detected during any trial with VE 20 or 25 l/min. With N2 dilution and the Puritan-Bennett 7200ae, NO2 (< or = 1 ppm) was detected only at a VE of 5 l/min with an FIO2 of 0.87 and [NO] > or = 70 ppm. In contrast, [NO2] values were greater with the Servo 900C ventilator than with the Puritan-Bennett 7200ae at similar settings. When NO was diluted with air, clinically important [NO2] values were measured with both ventilators at high [NO] and FIO2. Rate constants were 1.46 x 10(-9) ppm-2.min-1 when NO was mixed with N2, 1.17 x 10(-8) ppm-2.min-1 when NO was blended with air, and 1.44 x 10(-9) ppm-2.min-1 in the test lung. Conclusions [NO2] increased with increased FIO2 and [NO], decreased VE, blending with air, and increased lung volumes. Higher [NO2] was produced with the Servo 900C ventilator than the Puritan-Bennett 7200ae because of the greater residence time. With long intrapulmonary residence times for NO, there is a potential for NO2 production within the lungs. The rate constants determined can be used to estimate [NO2] in adult mechanical ventilation systems.

The Pathophysiology of Nitrogen Dioxide During Inhaled Nitric Oxide Therapy

ASAIO Journal ◽  
2017 ◽  
Vol 63 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Priscilla C. Petit ◽  
David H. Fine ◽  
Gregory B. Vásquez ◽  
Lucas Gamero ◽  
Mark S. Slaughter ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Nitrogen Dioxide ◽  
Inhaled Nitric Oxide ◽  
Nitric Oxide Therapy

scholarly journals MINIMIZING NITROGEN DIOXIDE EXPOSURE DURING INHALED NITRIC OXIDE THERAPY.2105

1996 ◽  
Vol 39 ◽  
pp. 353-353 ◽  
Author(s):  
Krisa P Van Meurs ◽  
Gregory M Sokol ◽  
Linda L Wright ◽  
Oswaldo Rivera ◽  
William J Thom
Keyword(s):  
Nitric Oxide ◽  
Nitrogen Dioxide ◽  
Inhaled Nitric Oxide ◽  
Nitric Oxide Therapy

scholarly journals Nitrogen Dioxide Formation during Inhaled Nitric Oxide Therapy

1999 ◽  
Vol 45 (3) ◽  
pp. 382-387 ◽  
Author(s):  
Gregory M Sokol ◽  
Krisa P Van Meurs ◽  
Linda L Wright ◽  
Oswaldo Rivera ◽  
William J Thorn ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Nitrogen Dioxide ◽  
Rate Constant ◽  
Tunable Diode Laser ◽  
Inhalation Therapy ◽  
Base Case ◽  
Laser Absorption ◽  
No2 Formation ◽  
Nitric Oxide Therapy ◽  
Diode Laser Absorption

Abstract Background: Nitrogen dioxide (NO2) is a toxic by-product of inhalation therapy with nitric oxide (NO). The rate of NO2 formation during NO therapy is controversial. Methods: The formation of NO2 was studied under dynamic flows emulating a base case NO ventilator mixture containing 80 ppm NO in a 90% oxygen matrix. The difficulty in measuring NO2 concentrations below 2 ppm accurately was overcome by the use of tunable diode laser absorption spectroscopy. Results: Using a second-order model, the rate constant, k, for NO2 formation was determined to be (1.19 ± 0.11) × 10−11 ppm−2s−1, which is in basic agreement with evaluated data from atmospheric literature. Conclusions: Inhaled NO can be delivered safely in a well-designed, continuous flow neonatal ventilatory circuit, and NO2 formation can be calculated reliably using the rate constant and circuit dwell time.

scholarly journals An Appraisal of Techniques for Administration of Gaseous Nitric Oxide

1993 ◽  
Vol 21 (6) ◽  
pp. 844-847 ◽  
Author(s):  
J. Tibballs ◽  
M. Hochmann ◽  
B. Carter ◽  
A. Osborne
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
High Pressure ◽  
Nitrogen Dioxide ◽  
Low Pressure ◽  
Variable Concentration ◽  
Pressure Oxygen ◽  
Pulmonary Vasodilator ◽  
Inspiratory Limb ◽  
High Pressure Oxygen

Gaseous nitric oxide (NO) is a potent selective pulmonary vasodilator. When mixed with O2 for more than 10-15 minutes it forms toxic amounts of nitrogen dioxide (NO2). We describe two techniques to administer 20 parts per million (ppm) during mechanical ventilation. A technique using flows of NO and O2 at low pressure to drive a Siemens Servo 900C ventilator provided a constant inspired concentration of NO. Another technique in which NO was added to the inspiratory limb of a Siemens Servo 900C ventilator driven by high pressure oxygen provided a highly variable concentration (9-53 ppm) of inspired NO.

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