Hertzog James H, Burr Katlyn L, Stump Angela, Brown Joel M, Penfil Scott, McMahon Kimberly
Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States.
Division of Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States.
J Pediatr Intensive Care. 2020 Dec;9(4):261-264. doi: 10.1055/s-0040-1710057. Epub 2020 Apr 24.
Inhaled nitric oxide (iNO) may be continued during the transition from invasive to noninvasive respiratory support. Upper airway obstruction from laryngeal edema following extubation and lower airway obstruction from asthma and bronchiolitis may be managed with inhaled helium. The coadministration of helium with iNO and the impact on delivered amounts of iNO have not been extensively studied. A bench model simulating a spontaneously breathing infant received iNO at varying preset doses delivered with either helium-oxygen or nitrogen-oxygen via a Vapotherm unit. iNO levels were measured at the simulated trachea. Results from the two conditions were compared using t-tests. When nitrogen-oxygen was used, there was no difference between preset and measured iNO levels. A significant difference was present when helium-oxygen was used, with a 10-fold increase in measured iNO levels compared with preset values. The use of helium resulted in a significant increase in measured iNO at the level of the simulated trachea. Clinicians must be aware that iNO will not be delivered at prescribed doses when used with helium under the conditions used in this study.
在从有创呼吸支持过渡到无创呼吸支持的过程中，可继续使用吸入一氧化氮（iNO）。拔管后喉水肿引起的上气道梗阻以及哮喘和细支气管炎引起的下气道梗阻可用吸入氦气治疗。氦气与iNO联合使用及其对iNO输送量的影响尚未得到广泛研究。一个模拟自主呼吸婴儿的实验台模型通过Vapotherm装置以氦氧或氮氧输送不同预设剂量的iNO。在模拟气管处测量iNO水平。使用t检验比较两种情况的结果。当使用氮氧时，预设和测量的iNO水平之间没有差异。当使用氦氧时，存在显著差异，测量的iNO水平比预设值增加了10倍。使用氦气导致模拟气管水平处测量的iNO显著增加。临床医生必须意识到，在本研究使用的条件下，当iNO与氦气一起使用时，其输送剂量将不符合规定。
