Oxygen Index
When should you get an Oxygen Index?
To assess the potential need for Inhaled Nitric Oxide and ECMO
What atmospheric gas does helium replace when used as a breathing gas?
Nitrogen
At what point after initiation of INO should you get the first met hgb?
2 hours
How does inhaled Nitric Oxide decrease Pulmonary Hypertension?
Selective and Potent pulmonary vasodilator
What is another name for Nitrogen Therapy in the hospital?
Hypoxic Gas Therapy
What does the Oxygen Index measure?
The intensity of ventilator support needed to Oxygenate a patient.
What 3 conditions of the medium airways are traditional diseases treated with heliox therapy?
Asthma, Croup, Chronic Obstructive Disease
At what point after initiation of INO does the Methemeglobin reach a steady state?
8 hours
What is the requirement from many Insurance companies to cover the cost of iNO?
Two Oxygen Indexes greater than 20 prior to initiation of INO
How does Nitrogen therapy work?
Constricting the vessels to relieve pulmonary over circulation
At what Oxygen Index would you consider Inhaled Nitric Oxide?
20 or greater
How much faster does Helium diffuse than Oxygen?
2.8 times faster
At what percentage of methemoglobin should you alert the physician and wean or turn off the INO?
5%
What two tests do you have to consider when initiating INO?
Oxygen Index and MetHgb.
In what types of patients has Nitrogen been considered
Single Ventricle and Parallel circulation before Norwood procedure
At what Oxygen Index would you consider ECMO?
Greater than 30-40.
Patients with an OI between 25-40 have >40% chance of death
When using an air flowmeter and 100% helium for Heliox mix on an oscillator, what is the conversion factor for the flowmeter?
2.8
If the methemoglobin level is greater than ________ you must repeat the test daily until less than ______.
1, 1
What multicenter study is currently looking at the safety and scientific validity of the use of INO in CDH?
The NO-NO trial
What is the lowest level of Oxygen you can safely provide a patient?
16%
What is the formula for Oxygen Index?
OI = (FiO2 * Mean Airway Pressure) / PaO2
Due to the increased tendency for laminar flow and reduced resistance, Heliox can increase the _____ in patients in Pressure Control Ventilator, or lower the ______ in patients in volume guarantee.
Tidal Volume, Peak Inspiratory Pressure
What disease states, compounded by the "functional hemoglobin's" decreased ability to release Oxygen, are most compromised by elevated MetHgb?
Anemic, CHF, COPD, Cyanotic Congenital heart defects
What bacteria associated with Cystic Fibrosis does INO serve as a potential antibacterial agent against in high doses?
Mycobacterium Abscessus
Why has Nitrogen Therapy fallen out of favor for treating pulmonary over circulation?
Recent studies show there is no statistical improvement in outcomes regardless of treatment.