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A portable nitric oxide scavenging system designed for use on neonatal transport

Dhillon, Jasvinder S. MB BS, FRCPC; Kronick, Jonathan B. MD PhD, FRCPC; Singh, Narendra C. BSc MB, BS, FRCPC; Johnson, Craig C. BA RRT

Pediatric Critical Care

Objective  To evaluate a portable scavenging system for nitric oxide and its oxides, designed for use on neonatal transport.

Design  A prospective evaluation of the nitric oxide scavenging system, using a neonatal transport incubator ventilator and a test lung.

Setting  Laboratory of a tertiary care children's hospital.

Interventions  The scavenging system was tested, using a neonatal transport incubator with attached ventilator, ventilator circuit, and a neonatal test lung. Nitric oxide was administrated on the inspiratory limb, and nitric oxide and its oxides were measured in the expiratory gas after passing through the scavenger.

Measurements and Main Results  A modified scrubber assembly was filled with 50% activated charcoal and 50% aluminas potassium permanganate pellets [3]. Three wire meshes were placed before, in between, and after the two chemicals to facilitate gas flow. Using the maximum FIO2, with a nitric oxide concentration of 120 parts per million (ppm), the test lung continuous flow ventilation (FIO2 of 0.86, peak inspiratory pressure of 30 cm H2 O, positive end-expiratory pressure of 6 cm H2 O, and respiratory rate of 60 breaths/min) was performed for 4 hrs with each of four freshly prepared scavenging systems. A fifth scavenging system was tested for a 12-hr period. The mean composition of the exhaled gases for 4 hrs were: nitric oxide 0.01 plus minus 0.03 (SD) ppm, nitric dioxide 0.06 plus minus 0.06 ppm, and other oxides 0.05 plus minus 0.09 ppm. After 12 hrs of 120 ppm of inhaled nitric oxide, the fifth scavenger system had undetectable nitric oxide, nitric dioxide, and other oxides in the exhaled gas. Normal room air contained between 0.0 and 0.03 ppm of nitric oxide, 0.0 and 0.02 ppm of nitric dioxide, and 0.0 and 0.02 ppm of other oxides.

Conclusion  Nitric oxide, nitric dioxide, and other dioxides can be safely scavenged by this portable scavenging system, allowing safe administration of nitric oxide free from environmental contamination with nitric oxide and its oxides.

(Crit Care Med 1996; 24:1068-1071)

From the Paediatric Critical Care Unit, Department of Paediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London, ON, Canada.

Address requests for reprints to: Dr. Jonathan B. Kronick, Department of Paediatrics, Children's Hospital of Western Ontario, 800 Commissioners Road East, London, ON N6C 2V5, Canada.

© Williams & Wilkins 1996. All Rights Reserved.