iNOVENT
iNO
May use if known pulmonary hypertension, or severe ARDS (usually when ECMO is being considered).
A trial of <30ppm is used, and will last 4 hours maximum
Responders: Improvement in oxygenation parameters of 20% by 30 mins
If no response stop iNO: prolonged treatment can cause rebound deterioration when iNO is stopped despite apparent non-response
It takes 5 - 10 mins after dialling a change in iNO concentration to achieve steady state
Methaemoglobin levels should be checked daily (should be < 5%) while on iNO • Weaning: when FiO2 < 0.50, reduce in 5ppm increments. Once at 5ppm, reduce in 1ppm increments
Sildenafil 0.3mg/kg qds may be used to aid weaning.
Setting up
1. Connect to power supply
2. Turn power on
3. Purge NO2 from circuit: -
a. Turn one of the NO cylinders on.
b. Check pressure gauge on front - ensure above 200psi. If pressure is less than 200psi, the cylinder needs to be changed.
c. Turn cylinder off again.
d. Disconnect low pressure connection hose between cylinder and back of delivery system, and reconnect it to the purge system manifold.
e. Wait a few seconds (> 15secs) until the noise of gas hissing stops, and the pressure gauge drops to zero.
f. Re-connect the low pressure hose to the delivery system.
g. Repeat steps a - f for the other cylinder.
4. Ensure Injector module is correctly connected - the arrow shows the direction of gas flow.
5. Insert the injector module into the ventilator circuit PROXIMAL to the humidifier i.e. between the ventilator and the humidifier.
6. Connect the inspiratory gas sample line to the inspiratory limb of the ventilator.
7. Turn on the ventilator to desired settings.
8. Turn on one NO cylinder.
9. Press 'Set NO' button on INOvent display.
10. Use rotary knob to set the desired NO concentration
11. Press the rotary button onward to confirm the setting.
12. Set Alarm limits within 20% either side of the desired NO setting
13. Set NO2 alarm limit to 1.5ppm
Nitric oxide will be delivered at the specified concentration. It takes around 5 minutes to reach stability.
A manual bagging circuit should be connected at all times to the INOvent in case of a ventilator disconnect.
To turn this on set the O2 flow meter to 15L/min. The manual circuit will deliver 20ppm nitric oxide.
Make sure the float valve is indicating flow on the front right hand side of the INOvent.
Make sure the flow meter is turned off when not in use.
Changing the cylinder
1. Perform a purge of the new cylinder as in the step 3a - f above.
2. Turn the new cylinder on.
3. Turn the old cylinder off.
4. Arrange for a ventilator technician to change the empty cylinder as soon as practicable.
The cylinder contains 1500L of NO at a concentration of 400ppm. Used on HFOV at a bias flow of 20L/min and a set concentration of 20ppm, this gives a lifespan of 24 hours.
