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CAPHC Guidelines for Inhaled Nitric Oxide in Neonates: Dosing, Administration and Weaning
Disclaimer:
This guideline represents the views of the CAPHC Inhaled Nitric Oxide Collaborative and was arrived at after careful consideration of the available evidence as well as a consensus building process. The guideline does not override the responsibility of individual clinicians and organizations to make decisions and provide the most appropriate care to infants, children and youth in consultation with the patient and family/guardian.
Introduction
Preamble
Despite generally good quality evidence to guide the use of inhaled nitric oxide (iNO) in term and near-term newborns, a recent survey conducted by CAPHC demonstrated considerable variation in practice across NICUs in Canada. Moreover, the high cost of iNO and recent trends toward increasing off-label use (1) necessitates a critical re-examination of the role of iNO in neonatal intensive care. The Canadian consensus guidelines contained herein were therefore developed with the goal of promoting safe, rational and cost-effective use of iNO therapy in newborns. more...
Guideline Recommendations
- Conditions
- Inclusion Criteria
- Policy
- Contraindications/Cautions
- Equipment and Procedure
- Monitoring and Documentation
- Prior to Administration of iNO
- Starting Dose
- Assessment of Response
- Weaning
- Monitoring for Complications
Guideline Development Process
Guideline Review
A review of hospital guidelines for administration of inhaled Nitric Oxide (iNO) was completed. Eighteen documents from eleven hospitals across Canada and a systematic review of the literature, the American Association for Respiratory Care: Evidence-Based Clinical Practice Guideline: Inhaled Nitric Oxide for Neonates With Acute Hypoxic Respiratory Failure, were analyzed. There are two documents from IWK Health Centre. The first document is a literature review and guideline from 2006 and the second is a guideline with some content based upon the first document. Two of the documents from London Health Science Centre consisted of tables used to document monitoring levels. more...
Glossary
ABG Arterial Blood Gas
ARDS Acute Respiratory Distress Syndrome
CCM Critical Care Medicine
CCU Critical Care Unit
CDH Congenital Diaphragmatic Hernia
ECMO Extracorporeal membrane oxygenation
FiO2 Fraction of Inspired Oxygen
iNO Inhaled Nitrogen Oxide
MPAW Mean Airway Pressure
MRSP Medical Readiness Strategic Plan
NICU Neonatal intensive Care Unit
NO Nitric Oxide
OI Oxygenation index (OI) = Mean airway pressure (MPAW) × FiO2 × 100
OR Operating Room
PaO2 Partial Pressure of Oxygen in Arterial Blood
PICU Pediatric Intensive Care Unit
ppm Parts per million
PPROM Preterm Premature Rupture of Membranes
PPHN Persistent pulmonary hypertension of newborn
PVR Pulmonary Vascular Resistance
RDS Respiratory Distress Syndrome
RRT Registered Respiratory Therapist
SaO2 Arterial Oxygen Saturation
SpO2 Saturation of Peripheral Oxygen
SvO2 Venous Oxygen Saturation
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