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Comparison of two administration techniques of inhaled nitric oxide on nitrogen dioxide production

Abstract

The purpose of this study was to verify whether, compared with the introduction of the NO-N2 mixture at the air inlet of the ventilator (classical method), a direct injection of NO-N2 into the inspiratory line of the ventilator circuit with a new injection device (new method), would reduce NO2 formation by reducing contact time between O2 and NO. The effect of two FiO2 (0.21 and 0.90) and NO concentrations on NO2 production was determined. In the classical method, NO and O2 were mixed with an air/oxygen blender before the gas mixture entered the ventilator. In the new method, NO was injected directly into the inspiratory line with the injection system. Nitric oxide and nitrogen dioxide gases were measured using a chemiluminescence analyzer. For aFiO2 of 0.90 and 90 ppm of NO, the amount of NO2 produced was decreased from 8.9 ± 0.8 ppm (mean ± SD) with the classical injection system to 4.4 ± 0.2 ppm with the new injection system (P = 0.0039, Mann-Whitney test), and NO2 production was decreased from 4.5 ± 0.2 ppm to 2.1 ± 0.4 ppm (P = 0.02) at 60 ppm of NO. However, at aFiO2 of 0.21, no difference was found in the amount of NO2 produced. We conclude that, compared with the classical method of NO administration, the new NO injection system reduces considerably the concentration of inhaled NO2 when a highFiO2 and a high concentration of NO are used.

Résumé

Cette étude avait pour but de vérifier, si, comparativement à la méthode d’introduction du mélange NO-N2 par l’orifice d’admission d’air du ventilateur (méthode usuelle), l’injection directe du NO-N2 dans la branche inspiratoire du circuit du ventilateur grâce à un nouveau dispositif d’injection (nouvelle méthode), réduisait la formation de NO2 en diminuant la phase de contact entre O2 et NO. L’influence de deuxFiO2 (0,21 et 0,90) et de différentes concentrations de NO a été établie. Dans la méthode usuelle, NO et O2 sont réunis à l’aide d’un mélangeur d’air et d’oxygène avant leur introduction dans le ventilateur. Dans la nouvelle méthode, NO est injecté directement dans la branche inspiratoire grâce au dispositif d’injection. L’oxyde nitrique et le dioxyde d’azote ont été mesurés par chimioluminescence. Pour uneFiO2 de 0,90 et 90 ppm de NO selon la méthode usuelle, la quantité de NO2 produite avec le nouveau système d’injection a diminué de 8,9 ± 0,8 ppm (moyenne ± ET) à 4,4 ± 0,2 ppm (P = 0,0039, épreuve de Mann-Whitney) alors qu’à 60 ppm de NO, la production de NO2 est passée de 4,5 ± 0,2 ppm à 2,1 ± 0,4ppm (P = 0,02). Cependant, sous uneFiO2 de 0,21, on n’a pas trouvé de différence en rapport avec la production de NO2 Les auteurs concluent que, comparativement à la méthode usuelle d’administration du NO, la nouvelle méthode par injection diminue considérablement la concentration inspirée de NO2, lorsque laFiO2 et la concentration de NO sont toutes les deux élevées.

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Correspondence to Gilbert Blaise.

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Dubé, L., Francoeur, M., Troncy, E. et al. Comparison of two administration techniques of inhaled nitric oxide on nitrogen dioxide production. Can J Anaesth 42, 922 (1995). https://doi.org/10.1007/BF03011041

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Key words

  • gases: nitric oxide, nitrogen dioxide, oxygen
  • toxicity: nitrogen dioxide
  • equipment: blenders, injection systems, ventilators