Nitric Oxide

[KR]

Hello! I just started a new travel assignment. This is the fourth hospital that I have worked at, but they are the FIRST hospital that I have worked at that has used Nitric Oxide. I had never even heard of that before. I took care of a patient that was septic and had ARDS. She was on Vec., Ativan, and Morphine drip. Train of four was kept at 0 or 1/4. Her vent settings were as follows:

PVC ventilation

rate 24

18 PEEP

28 Peak inspiratory pressure

Oxygen had been at 100% RT and I weanted it down to 65%

(of course the weaning was done after she had bilateral CT for pneumo's and drained 500 cc of effusion off her lungs)

and 60 PPM Nitric Oxide.

RT and the other nurses in the know, said that Nitric Oxide has a very short half life, does not build up in the system, used to treat pulmonary HTN, that is has a vasodilation effect. The docs said that it is a last ditch effort, but that it has worked in some cases.

I was just wondering if anyone knew of any literature on this??

Thanks for the input!

Kimberly

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Do a search in an engine such as google

I did a search for Nitric oxide in ARDS and found this.

It is in Medscape so you will have to register to read this.

http://www.medscape.com/viewarticle/417909

Hope this helps. I have seen it used only once in an ARDS pt who was also severely septic. All I can remember is that it is one of the "new" standard therapies.

[zcubed]

http://www.ctsnet.org/doc/1743

http://www.ctsnet.org/doc/1743

http://ardsusa.org/Inhaled-NO.htm

I am an ARDS/sepsis survivor. Next course of action will probably be steriods, but why not xigris??? very expensive...

[MarkHammerschmidt]

Hi KR - yup, when it's run through the vent circuit, NO has a nice vasodilatory effect on stiff lungs - you should see something like a 25-30% drop in mean PA pressures, or something like that, if it's really working. Which it doesn't always, unfortunately. The idea is to try to reduce the stiffness of the lungs, which reduces the barotrauma from the high vent settings, which allows the lungs to get better.

[prmenrs, RN]

It is used in neonates for post op cardiac surgeries (like banding proceedures where they don't want the O2 sat too high to protect the lungs, and for problems w/persistent fetal circulation w/pulmonary hypertension. Works nicely.

[KR]

Thanks for all the information and opinions:) It is really appreciated. As far as xigris goes, I believe it would be contraindicated because she keeps dropping her Hemoglobin and HCT. She had surgery couple weeks ago and also delivered a couple weeks ago. Kimberly