The Use of Nitric Oxide in Intensive Care Ventilation

Wassim Sukari, M.D.

Occurrence of NO in the Body

Vaso-m uscu la ture

B lood ce lls

M acrophages

M em ory

N O

How does NO act at cellular levels?

Metabolism of NO in the Body

Potential Uses of NO

PF C PPH N

H eart fa ilure

N eonates

H ear fa ilure

C hildren

H eart fa ilure ALI A R D S

C O PD

Adults

N O

Circulation in Adults

Circulation in the foetus

Effects of vascular regulation on blood flow and its distribution in lung and body circulation depending

on are affected

C hange in d istributionof b lood flow

For s inglr organswithin the lung

C hange inblood pressure

For a ll organsfor the whole lung

Vascular regulationchange in resistance

Vaso-constriction and Vaso-dilation in Alveoli

Direct and Indirect Consequences of Hypoxia

Organ failure

Inadequateoxygen supply

Pulm onaryhypertension

Increase inpulm anary vascular

resistance

Hypoxia

Direct and Indirect Consequences of Pulmonary Hypertension

Heart failure

Increased afterloadon right ventricle

Lungoedem a

Increase infiltration pressure

in the lung

Hypoxia

Reversal ofintra- or extra-cardial shunt

Pulm oanaryhypertension

Comparison Between Inhaled NO and Infused Vasodilators

NO Infused vaso-dilator

PaO2

Shunt

MPAP

MAP

Risks of NO Inhalation

NO, NO2, NO3 Cell toxicityMutagenesis

HNO2, HNO3 OedemaIncreased airway resistance

MetHb Internal asphyxia

Displacement of oxygen Oxygen shortage

Influence on blood clotting Haemorrhage

Influence on endogenousNO production

Rebound effects

Diagram of Ventilation with NO Flow Control

Components of NOdomo

Effects of NO Inhalation on Ventilation

Increase inpressure

Volum e controolledventilatore

Pressure levelis achieved

m ore rapidly

Pressure controlledventilators

D ilution ofinspiratory oxygen

concentration

General

NO supply