Production of nitrogen dioxide during nitric oxide therapy using the Servo Ventilator 300 during volume-controlled ventilation.

Abstract

Inhaled nitric oxide may be useful in the treatment of pulmonary hypertension and hypoxaemia. Nitric oxide is rapidly oxidized to nitrogen dioxide, which is toxic and may adversely affect the airways of the patient. The aim of the present investigation was to examine factors that may affect the concentration of nitrogen dioxide, using the Servo Ventilator 300 nitric oxide delivery system, where nitric oxide is flow-proportionally mixed with the main ventilatory flow in the proximal part of the inspiratory limb. In this experimental study nitric oxide and nitrogen dioxide levels were measured at the inspiratory site of a Y-piece with a chemiluminescence analyzer and electrochemical fuel cells. The effects of different concentrations of nitric oxide and oxygen, minute volume, different tube lengths, a soda lime absorber, and a humidifier placed in the inspiratory limb were evaluated. The concentration of nitrogen dioxide was dependent on the concentrations and residence time of nitric oxide with oxygen and the minute volume ventilation used. A soda lime absorber reduced concentrations of nitrogen dioxide at the expense of almost corresponding reductions in inhaled concentrations of nitric oxide. A humidifier increased the concentration of nitrogen dioxide, to an extent depending on the water volume and temperature used. Concentrations of nitric oxide and oxygen, minute volume ventilation, and residence time in the inspiratory part of the ventilatory circuit were factors that affected the generation of nitrogen dioxide. A soda lime absorber in this system is not recommended.