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British Journal of Anaesthesia, Vol 81, Issue 4 544-552, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia

LABORATORY INVESTIGATIONS

Performance of proportional and continuous nitric oxide delivery systems during pressure- and volume-controlled ventilation

M. J. Hiesmayr, T. Neugebauer, A. Lassnigg, H. Steltzer, W. Haider and H. Gilly
Department of Cardiothoracic Anaesthesia and Critical Care Medicine, University Hospital AKH, University of Vienna, Austria; Department of General Anaesthesia and Critical Care Medicine, University Hospital AKH, University of Vienna, Austria; Ludwig Boltzmann Institute for Experimental Anaesthesiology and Research in Intensive Care, University Hospital AKH, University of Vienna, Austria

We have evaluated the effect of delivering nitric oxide using a continuous flow system (CFS) or two commercially available proportional gas injection systems (PGIS), Nodomo (Drager, Lubeck, Germany) and Pulmonox-Mini (Messer Griesheim Austria, Gumpoldskirchen, Austria) on measured and simulated concentrations of nitric oxide. Nitric oxide concentration was measured in a bench test at five sites in the inspiratory breathing system during volume- or pressure-controlled ventilation and mathematically simulated using a mixing chamber model. For a target concentration of 10 parts per million (ppm) at the "Y" piece, simulated nitric oxide concentrations were 1.9-139 ppm for CFS, 0.3-22 ppm for the Nodomo and 0.0-31 ppm for the Pulmonox-Mini near the nitric oxide administration site. However, peak concentrations decreased rapidly along the inspiratory system. Measured and simulated variations depended on the nitric oxide delivery system, site of measurement and tidal volume. Measured variations were four times smaller in the Nodomo than in the Pulmonox-Mini and CFS. As inappropriate mixing may occur even with PGIS, nitric oxide should probably not be administered near the "Y" piece.
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