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By;
Saja A. AL-marshad
Senior RT student
Dammam university
Saudi arabia
Ohat is iNO ??
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‡ iNO is a selective pulmonary

vasodilator

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‡ Three American researchers

recently won the Nobel Prize for
their work in the 1970s and 80s in
characterizing nitric oxide¶s role in
the relaxation of blood vessels.
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‡ In December 1999 the U.S. Food and

Drug Administration approved the use of
inhaled NO as a pulmonary vasodilator for
the treatment of hypoxic respiratory failure
(HRF) in full- and near-term infants
(greater than 34 weeks gestation).
‡ This gas is administered by special
instruments developed using different
techniques.
‡ For precise and safe delivery, the
monitoring of the levels of nitric oxide and
nitrogen dioxide is essential
 Pulmonary
Indications of
Inhaled Nitric
Review of clinical studies: Oxide

Indications of
Nitric Oxide
Heart and and Various Sickle Cell
Lung Surgery Clinical Disease
Applications

One-lung
Ventilation
 Pulmonary Indications of Inhaled
Nitric Oxide:

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Inhaled nitric oxide therapy shows beneficial or no or
worsen results in various clinical situations where
pulmonary hypertension is pertinent. The following are
the diseases that causes PHN that iNO was
investigated with;
hypoxemia COPD IPF

IRDS PPHN PHN

CABG
hypoxemia

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COPD

±


,
reports of worsening
oxygenation with inhaled
nitric oxide shows broad
V/Q heterogeneity and
the presence of low V/Q
areas.
IRDS
Nitric oxide is supposed to work by
improving gas exchange through ventilation-
perfusion
matching and reducing pulmonary vascular
resistance. Its
exact mechanism of action in RDS is not
completely
understood.
documented improved oxygenation in 23
premature neonates at doses of 5-20
ppm. This effect was dose-independent
CABG

Inhaled nitric oxide is

the medication of choice for treatment of pulmonary
hypertension and hypoxemia following
cardiopulmonary bypass or the use of a ventricular
assist device for mitral valve replacement .coronary
artery bypass graft , heart or lung transplantation,
and pulmonary embolism.

³ all absorbed in studies´

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‡ Expired nitric oxide has been suggested

as a marker of severity and therapeutic
response in asthmatics.

‡ Exhaled nitric oxide has been shown to

increase proportionally to airway
inflammation in several studies .
‡ The data on inhaled nitric oxide therapy in
asthma patients are  c
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inhaled nitric oxide in the range of 2-40

ppm is effective in reducing elevated
pulmonary vascular resistance and does
not increase cardiac work.
 PVR

hypoxemia vasodilatation
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Diffusion:
iNO ‡

Binds with hemoglobin ‡

methemoglobin (metHgb), ‡
O % )c
(

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weaned from 20
to 5 ppm in Monitor
   *%
+
decrements of 5 &
,-.-
ppm every 1 to 2 monitor
hours
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ß
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(
‡ This probably results from suppression by
iNO of endogenous NO production.

‡ Rebound pulmonary hypertension is a risk

with cessation of iNO from even low doses
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iNO therapy, and regardless of whether

the infant initially responded to iNO
 Ohat do u think may cuz the discunnection of
the iNO therapy ??
³related to RTz work´
1. during suctioning
2. malfunction of the ventilator.

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‡ be certain that the bag system
‡ (for manual ventilation) is set up to deliver iNO at the time of
the onset of iNO therapy.
Device component:
 INOvent Bedside Delivery System ‡
http://inomax.com/assets/pdf/INOvent- ‡
Operation-Manual.pdf

INOmax DS: The latest advance in ‡

INOMAX delivery systems

http://inomax.com/assets/pdf/INOblender- ‡
Operation-Manual.pdf
Thanxx

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