Modes of administration of nitric oxide devices and ventilators flow-by impact the delivery of pre-determined concentrations
Rattachement africain : fr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Nitric oxide (NO) is a strong vasodilator, selectively directed on pulmonary circulation through inhaled administration. In adult intensive care units (ICU), it is mainly used for refractory hypoxemia in mechanically ventilated patients. Several medical delivery devices have been developed to deliver inhaled nitric oxide (iNO). The main purpose of those devices is to guarantee an accurate inspiratory NO concentration, whatever the ventilator used, with NO 2 concentrations lower than 0.3 ppm. We hypothesized that the performances of the different available iNO delivery systems could depend on their working principle and could be influenced by the ventilator settings. The objective of this study was to assess the accuracy of seven different iNO-devices combined with different ICU ventilators’ flow-by to reach inspiratory NO concentration targets and to evaluate their potential risk of toxicity. We tested seven iNO-devices on a test-lung connected to distinct ICU ventilators offering four different levels of flow-by. We measured the flow in the inspiratory limb of the patient circuit and the airway pressure. The nitric oxide/nitrogen (NO/N 2 ) flow was measured on the administration line of the iNO-devices. NO and NO 2 concentrations were measured in the test-lung using an electrochemical analyzer. We identified three iNO-device generations based on the way they deliver NO flow: “ Continuous ”, “Sequential to inspiratory phase” ( I-Sequential ) and “Proportional to inspiratory and expiratory ventilator flow” ( Proportional ). Median accuracy of iNO concentration measured in the test lung was 2% (interquartile range, IQR -19; 36), -23% (IQR -29; -17) and 0% (IQR -2; 0) with Continuous, I-Sequential and Proportional devices , respectively. Increased ventilator flow-by resulted in decreased iNO concentration in the test-lung with Continuous and I-Sequential devices, but not with Proportional ones. NO 2 formation measured to assess potential risks of toxicity never exceeded the predefined safety target of 0.5 ppm. However, NO 2 concentrations higher than or equal to 0.3 ppm, a concentration that can cause bronchoconstriction, were observed in 19% of the different configurations. We identified three different generations of iNO-devices, based on their gas administration modalities, that were associated with highly variable iNO concentrations’ accuracy. Ventilator’s flow by significantly impacted iNO concentration. Only the Proportional devices permitted to accurately deliver iNO whatever the conditions and the ventilators tested.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Modes of administration of nitric oxide devices and ventilators flow-by impact the delivery of pre-determined concentrations
- Date Crossref
- 01/01/2024
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Université d'Angers pays non établi dans la noticeUniversité ou école supérieure
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Air Liquide (France) pays non établi dans la noticeEntreprise
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Centre Hospitalier Universitaire Amiens-Picardie pays non établi dans la noticeÉtablissement de santé
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Hôpital Nord Medical Intensive Care Unit pays non établi dans la noticeÉtablissement de santé
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University of Angers pays non établi dans la noticeUniversité ou école supérieure
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University Hospital of Angers Vent'Lab pays non établi dans la noticeUniversité ou école supérieure
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Med2Lab pays non établi dans la noticeStructure de recherche
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iNOSystems pays non établi dans la noticeInstitution
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Amiens University Hospital Medical Intensive Care Unit pays non établi dans la noticeUniversité ou école supérieure
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Air Liquide Santé International pays non établi dans la noticeInstitution
Université d'Angers, Air Liquide (France) et Centre Hospitalier Universitaire Amiens-Picardie, avec 7 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.