iNO

Question 1

What is the highest dosage of iNO that should be given?

Answer 1

around 20 ppm because there is no clinical benefit about it and the hazards and complications are higher the more you go up in dosage

Question 2

Where in the body is endogenous Nitric Oxide relased from?

Answer 2

Parenasal sinuses

Question 3

What happens to iNO when it enters the body?

Answer 3

when inhaled and enters the blood stream then binding to Hb, it is inactivated

Question 4

iNO can be used to treat neonates with what?

8 conditions

Answer 4

MAS
Pneumonia
Sepsis
Idiopathic PPHN
RDS
CDH
Pulmonary hypoplasia

Premies

Question 5

Who do you not give iNO to?

Answer 5

Neonates with Ductal dependent Right to Left Shunt

Question 6

What are the hazards of iNO?

Answer 6

Rebound Hypoxemia – worse than what you started with

Methemoglobinemia - +2-+3

Increased NO2 – by contact with oxygen

Decreased platelets – agglutenation – decreases the ability for platelets to bind together.

Question 7

How do you take a patient off of iNO?

Answer 7

Attempt reduction to 5 ppm in first 4 to 48 hours

Decrease starting dose by 5 – 10 ppm until 5ppm or per policy

Once at 5 ppm, decrease by 1 until you get to 1 ppm

Leave on 1ppm for 30-60 minutes

Discontinue iNO and transiently increasing FiO2 ~10%

Question 8

What is the rebound Phenomena in iNO?

Answer 8

Hypoxemia worse than before tx

Can happen with abrupt discontinuation of iNO

Seen in administration of inhaled NO for extended periods of time
May even occur in “non-responders”

Question 9

Who is considered a non-responder to iNO therapy?

Answer 9

If there was less than a 20 mmHg increase in PaO2 after 30 minutes