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. 2020 Dec;9(4):261-264.
doi: 10.1055/s-0040-1710057. Epub 2020 Apr 24.

Impact of Helium-Oxygen Administered via High Velocity Nasal Insufflation on Delivery of Inhaled Nitric Oxide

James H Hertzog  1   2   3 , Katlyn L Burr  1 , Angela Stump  1 , Joel M Brown  1 , Scott Penfil  4 , Kimberly McMahon  2   3
Affiliations

Impact of Helium-Oxygen Administered via High Velocity Nasal Insufflation on Delivery of Inhaled Nitric Oxide

James H Hertzog et al. J Pediatr Intensive Care. 2020 Dec.

Abstract

Inhaled nitric oxide (iNO) may be continued during the transition from invasive to noninvasive respiratory support. Upper airway obstruction from laryngeal edema following extubation and lower airway obstruction from asthma and bronchiolitis may be managed with inhaled helium. The coadministration of helium with iNO and the impact on delivered amounts of iNO have not been extensively studied. A bench model simulating a spontaneously breathing infant received iNO at varying preset doses delivered with either helium-oxygen or nitrogen-oxygen via a Vapotherm unit. iNO levels were measured at the simulated trachea. Results from the two conditions were compared using t-tests. When nitrogen-oxygen was used, there was no difference between preset and measured iNO levels. A significant difference was present when helium-oxygen was used, with a 10-fold increase in measured iNO levels compared with preset values. The use of helium resulted in a significant increase in measured iNO at the level of the simulated trachea. Clinicians must be aware that iNO will not be delivered at prescribed doses when used with helium under the conditions used in this study.

Keywords: high flow nasal cannula; high velocity nasal insufflation; inhaled nitric oxide.

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Conflict of interest statement

Conflict of Interest K.B. is associated as a Patient Trainer, Hill-Rom. No conflicts of interest, financial or otherwise, exist for J. H. H., A. S., J. M. B., S. P., and K. M.

Figures

Fig. 1
Fig. 1
Inhaled nitric oxide measurements. PPM, parts per million.
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