O1057 Oct.4: 1:36pm - Novel Inhaled Nitric Oxide (iNO) Therapy Delivery Through a Neonatal Transport HIgh Frequency Percussive Flow Ventilator (HFPFV)

Background: Sick neonates may require transport high frequency ventilation (HFV) with inhaled nitric oxide (iNO). Hospital based HFV-iNO systems are not transport capable. The neonatal transport HFPFV (Percussionaire, Sandpoint, ID) and the AeroNOx iNO system (International Biomedical, Austin, TX) are transport capable. The iNOmaxDSIR iNO system (Mallinckrodt Pharmaceuticals, Bedminster, NJ) is not approved with HFPFV. In-line iNOMaxDSIR alters the HFPFV clinical performance. One iNO delivery system for intra- and inter-hospital use has advantages: (1) lower costs and (2) single system maintenance.
Primary Hypothesis: Effective iNO delivery can be achieved using side-stream iNOmaxDSIR injection into HFPFV. Secondary Hypothesis: The side-stream delivery will not clinically alter HFPFV pressure characteristics.
Methods (Figure). Set iNOMaxDSIR to inject 20 ppm iNO. A flowmeter connected to the injector module input ran at 2, 4 and 6 lpm (30 mins at each setting) to drive the iNO into the HFPFV output. The HFPFV settings: mean airway pressure (MAP) 14 cm H2O; fine wiggle (low amplitude); and a 500 bpm frequency through a 2.5 ETT - Neonatal Lung Model (Ingmar Medical, Pittsburgh, PA) with a 30% leak. This emulated neonatal respiratory distress syndrome treatment. The iNO concentrations were measured: (1) pre-injection in the HFPFV and (2) post-injection from the ETT adapter. ETT concentrations within 20% of 20 ppm iNO concentration, were considered acceptable. The Jet-HFV (Bunnell Inc, Salt Lake City, UT) monitor module measured: Peak Inspiratory Pressure (PIP), Peek End-Expiratory Pressure (PEEP), Delta Pressure (DP) and Mean Airway Pressure (MAP). INO and NO2 measurements from the iNOmaxDSIR were recorded.
Results (Table, pressures in cm H2O). Flowmeter 2 lpm: Frequency (bpm) 507 - 509; PIP 17.9 -18.3; PEEP 9.2 -10.3; DP 8.7 - 8.0, MAP 13.2 - 14.1; iNO Pre/Post 9/17 -18. Flowmeter 4 lpm: Frequency 509 – 517; PiP 20 - 19; PEEP 11.4 - 11.7; DP 8.6 - 7.3, MAP 15.5 - 15; iNO Pre/Post 13/18. Flowmeter at 6 lpm: Frequency 509 – 517; PiP 20 - 19.5; PEEP 12.3 -12.2; DP 7.7 - 7.2, MAP 16 - 15.5; iNO Pre/Post 15/18.
Conclusion. iNOMaxDSIR side-stream delivery achieved clinically effective levels of iNO in the ETT of a neonatal lung model. As the flow increased, there were slight increases in MAP and decreases in DP, not likely of clinical significance. The lower side-stream flows appear to give the best results with lower gas consumption. The increased medical gas flow requirements to drive the side-steam iNO will increase the consumption of medical gas by about 15 to 20% over the baseline 10 – 15 lpm HFPFV consumption. Further study with additional settings and ETT sizes are warranted. Future clinical use of the iNOMaxDSIR with the HFPFV may be possible.