Inhaled Nitric Oxide

               Katherine McCallie and Krisa Van Meurs

INDICATION

Clinical Findings

History

This protocol for use of inhaled nitric oxide (iNO) applies to neonates with gestational age 34 weeks or greater on mechanical ventilation with hypoxic respiratory failure. This protocol is not intended for any patient on an active research protocol involving nitric oxide or preterm infants less than 34 weeks’ gestational age.

Physical

Infants will have an elevated oxygenation index (OI) of 25 or greater on 2 arterial blood gases at least 15 minutes apart.

Confirmatory/Baseline Tests

1. OI =

FiO₂: fraction of inspired oxygen (eg, 50% FiO₂ = 0.5)

MAP: mean airway pressure, from ventilator

PaO₂: partial pressure of arterial oxygen, from arterial blood gas (ABG)

2. Echocardiogram

    a. Evaluate for structural heart disease, which may require surgical intervention.

    b. Evaluate for elevated right-sided heart pressures indicating pulmonary hypertension, as indicated by:

      1. Right ventricular or atrial dilation

      2. Interventricular septal bowing

      3. Elevated right atrial pressure as estimated by tricuspid regurgitation

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