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Nitric Oxide, Inhaled — Clinical Indicators — Clinical Pathway: ICU and Inpatient

Inhaled Nitric Oxide for Acute Hypoxemic Respiratory Failure Clinical Pathway — PICU

Clinical Indicators that that may alter weaning of iNO

Clinical Indicator Rationale Comments
Elevated Brain Natriuretic Peptide (BNP) compared to baseline if available or within laboratory limits If consistent with prior values or within available limits, BNP should not prevent weaning for true refractory hypoxemic respiratory failure.
  • An aggressive wean may not be appropriate.
  • Consider consult to pulmonary hypertension for evaluation for right sided heart failure
< 40% FiO2 iNO can be weaned more quickly if FiO2 is below this value
High Frequency Oscillatory Ventilation (HFOV), High Frequency Percussive Ventilation (HFPV/VDR) Does not preclude weaning of iNO If on HFPV/VDR, iNO can be weaned but the lower dose (ppm) increments will be dependent on the patient’s settings.

 

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