Specialty Gases (Mod 6) Flashcards
Nitric Oxide and Heliox
What functions does Nitric Oxide include?
- Vasodilation (potent)
- Neurotransmission
- Long term memory
- Immunologic defense
How could Nitric Oxide affect platelet adhesion?
Nitric Oxide would inhibit platelet adhesion
How could Nitric Oxide on the inflammatory response induced by mast cells?
Nitric Oxide would inhibit the inflammatory process by mast cells
What are expected physiological effects of Nitric Oxide?
Relaxation of smooth muscles
- when inhaled = potent vasodilator
Why is it beneficial to inhale Nitric Oxide (NO) rather than admin percutaneously?
Nitric Oxide is a selective pulmonary vasodilator, it only affects ventilated alveoli. Meaning…
- Vasodilation = Decreased PVR without decreasing SVR
- NO increases blood flow only to ventilated alveoli by relaxing the smooth muscles of the capillaries supplying these alveoli
When Nitric Oxide has been admined, what does the subsequent pulmonary vasodilation result in?
- Decreased intrapulmonary shunting
- Improved oxygenation
- Decreased PVR
- Decreased pulmonary artery pressures
Why doesn’t Nitric Oxidie effect SVR?
The effects of NO are limited to pulmonary circulation because after diffusing into the capillaries NO immediately binds to hemoglobin
- NO + hbg = nitrosylhemoglobin which is rapidly oxidized to methemoglobin (metHb)
Indications and potential uses for Nitric Oxide?
Look over, but don’t linger
Potential Uses
ARDS
PPHN
Primary pulmonary hypertension
Pulmonary hypertension post cardiac-Sx
Heart transplantation
Acute pulmonary embolism
COPD
Bronchodilation
Congenital diaphragmatic hernia
Congenital heart disease
Testing pulmonary vascular responsiveness
When would Nitric Oxide be used for Bronchodilation?
When bronchoconstriction results from histamine and/or methacholine challenges
What are the benefits of Nitric Oxide for pphn treatments?
NO reduces pulmonary pressure…therefore:
- Systemic pressures > Pulmonary pressures therefore:
- Shunting through PDA and PFO are stopped/reduced –> direct effect due to the reduced PAP (and decreased PVR)
Most common uses for Nitric Oxide?
NO is primarily used for its selective pulmonary vasodilator effects but
- Pulmonary Vasodilation
- Bronchodilation
When would pulmonary vasodilation be desired when using Nitric Oxide? (3)
- what pathos?
- PPHN
- Congenital heart defects (maintain pfo and pda)
- ARDS
When would bronchodilation be desired when using Nitric Oxide? (3)
To reverse methacholine or histamine induced bronchoconstriction
Nitric Oxide Therapeutic dose range?
2-20 ppm (Neo-20ppm)
- Beneficial effects peak at 10ppm in adult ARDS patients
When does the therapeutic dose of Nitric Oxide peak for adults with ARDS?
Around 10ppm
Nitric Oxide Starting dose in: Adults
Start at 10ppm followed by ABG 5 mins after initiation
- optimize to the lowest dose w/favorable response
How is Nitric Oxide dosage optimized?
Wean NO by 2-4 pm while monitoring SpO2 and mean PAP
- if SpO2 falls by >2% or mean PAP increases by > 5mmHg…return to last effective dose
P and P for Nitric oxide on adults
- Start at 10 ppm and do an ABG 5 min after initiation
- If no response (PaO2 increases <10 mmHg, SpO2 increases <2% or MPAP does not decrease by at least 5 mmHg) then increase to 20 ppm
After initiating Nitric Oxide for ARDS, what are the next steps if there is no response to treatment?
Discontinue NO (treatment failure)
After initiating Nitric Oxide for pulmonary hypertension, what are the next steps if there is no response to treatment?
10ppm (starting)–> 20 ppm–> 40ppm and assess response
Risk of high concentrations of Nitric Oxide?
NO Toxicity which can lead to acute pulmonary edema…than death
- Most toxic effects are due to its by products: NO2, Nitric Acid, and Methemoglobin
What range would Nitric Oxide toxicity be a concern?
NO toxicity would be expected at 5000-20,000 ppm
What would the lower end of Nitric Oxide toxicity involve?
Possible direct cellular damage and impaired surfactant production