"Nitric Headache?"

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Specializes in Neonatal ICU (Cardiothoracic).

Hi all,

I was at work the other day, caring for two kids on iNO, one on 20ppm, one on 10ppm, near several pods that also had kids on it, and had a whopper of a headache. I have been attributing the increased number of headaches I've had lately to the new job, stressful commute, lack of sleep, etc... But my preceptor suddenly said, "I'll bet you're just sensitive to all the iNO we've got going on around our pods!" :bugeyes:I know nitric is a selective pulmonary vasodilator, but can it also affect cerebral vasodilation? And is it even possible to breathe enough "loose" gas to even have an effect? Any ideas you all might have would be helpful!!!

Stephen

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Specializes in NICU, PICU, educator.

Yes! Make sure that the bags are turned off. There are times we all swear we can "taste" it when we have kids on really high doses and we check the bags and they are leaking! I, and many others, have gotten headaches when I am in the rooms that are enclosed. This is one of the reasons we don't allow pregnant girls to take care of nitrics because there is a risk to their placentas.

Now, if you have a migraine that wouldn't be a bad place to be:lol2::lol2:

This is what we have in our binders at work, it is from the CDC

http://www.atsdr.cdc.gov/MHMI/mmg175.html

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Yes! Make sure that the bags are turned off. There are times we all swear we can "taste" it when we have kids on really high doses and we check the bags and they are leaking! I, and many others, have gotten headaches when I am in the rooms that are enclosed. This is one of the reasons we don't allow pregnant girls to take care of nitrics because there is a risk of vasoconstriction of their placentas.

Now, if you have a migraine that wouldn't be a bad place to be:lol2::lol2:

Can you tell me how I can find the literature to support that. Or even the name and location of the NICU that has implemented that precaution. I would like to inform our management of that, because since I've gotten pregnant I seem to have an iNO kid every other week. But they tell me that if anything, it will help me to avoid getting pulmonary hypertension - never knew about the vasoconstriction.

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Specializes in NICU, PICU, educator.

I added the CDC link we use in my original post

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Specializes in NICU.

Our respiratory guru (an anaesthesiologist) SWEARS that there's no way that enough iNO escapes to cause us any problems and it's all in our heads. But spend a 12 in an isolation room with a kid on NCPAP with nitric? Dizzy, nauseated, migrainous. Our charge nurses try to keep the pregnant girls away from the nitric kids, but it doesn't always happen.

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Specializes in NICU.

Update: The last two nights my primary has been on 20ppm of iNO and requiring suctioning q15-30 mins and at least one nebulizer treatment per hour, so I end up detaching the vent constantly, as we don't use inline suction. By 0600 both shifts I was actually vomiting. This morning I felt the HA and dizziness coming so I went outside to get some air, but it didn't help. I left the unit two hours ago and I still feel sick. What I'm wondering is how on earth must the baby feel??? We're pumping that stuff into him at 10 Hz! No wonder he's such a crabbypants...

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Specializes in NICU.
Our respiratory guru (an anaesthesiologist) SWEARS that there's no way that enough iNO escapes to cause us any problems and it's all in our heads. But spend a 12 in an isolation room with a kid on NCPAP with nitric? Dizzy, nauseated, migrainous. Our charge nurses try to keep the pregnant girls away from the nitric kids, but it doesn't always happen.

This is the reason that our RTs tell us that we can't do nitric on NCPAP - there's too much rainout and we'd all be on nitric highs

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Specializes in level 3 NICU.

You should have went to the ED!!! You have been poisioned.! Our Resp Therapy dept tells us the same thing!! My own doc says diffrent. I too have been TRAPED for 12 hours in room with infants on iNO and I tell the charge nurse I am taking a break from this room q1h and I also always have a o2 bag for myself. I just breath a little o2 if i feel like I am starting to get a HA!

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Specializes in NICU.

Can't say I've ever seen a kid on NCPAP on iNO, wow.

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Specializes in NICU.
Can't say I've ever seen a kid on NCPAP on iNO, wow.

Well, we're kind of the anti-intubation crusaders at my place. Ever see a 400-grammer on CPAP?

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Specializes in NICU.
Ever see a 400-grammer on CPAP?

Actually yeah lol, and on nasal prongs. I've just never seen it with iNO.

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Specializes in NICU.

Oh, good. Maybe that means we're not as psychotic as I feared.

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