N/IICU Clinical Pathway for Inhaled Nitric Oxide Use in Newborns with Persistent Pulmonary Hypertension

  • Initiating iNO

  • Obtain baseline ABG
  • Initiate iNO 20 ppm
  • After 30 minutes, repeat ABG
  • Post-ductal PaO2 increase ≥ 20 mmHg or
  • Post-ductal SpO2 increased ≥ 5%
  • Post-ductal PaO2 increase < 20 mmHg or
  • Post-ductal SpO2 increased < 5%
  • Maintaining iNO at 20 ppm, wean FiO2 as follows*:

  • Titrate Fi02 to maintain post-ductal SpO2 94-98%
  • Do not wean FiO2 > 10 % per hour
  • Consider Discontinuing iNO

  • 25-30% of neonates will be
    non-responders to iNO therapy

  • When FiO2 ≤ 60%,

  • Wean iNO 20 to 10
  • While continuing to wean FiO2 as above, begin iNO weaning every 4 hours as tolerated
  • iNO Weaning Progression

  • 10
    5 ppm
  • 5
    3 ppm
  • 3
    2 ppm
  • 2
    1 ppm
  • Increase FiO2 by 10% and Turn iNO off
  •  
  • If patient does not tolerate wean, return to previous iNO ppm, resume wean after 4 hrs. After each iNO wean, wait 30 minutes before continuing to wean FiO2

*Weaning recommendations also apply to babies who arrive to CHOP on iNO
Posted: January 2016
Reviewed: April 2020
Authors: D. Munson, MD, M. Padula, MD, U. Nawab, MD, K. Nilan, RN, P. Clifford, RN, L. Tyler, RRT, J. Stoller, MD, K. Dysart, MD, L. Soorikan, MD, J. Carroll, M. Fraga, MD, E. Tkach, MD, J. Chuo J, MD