N/IICU Clinical Pathway for Inhaled Nitric Oxide Use in Newborns with Persistent Pulmonary Hypertension
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Initiating iNO
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Obtain baseline ABG
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Initiate iNO 20 ppm
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After 30 minutes, repeat ABG
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Post-ductal PaO2 increase ≥ 20 mmHg or
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Post-ductal SpO2 increased ≥ 5%
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Post-ductal PaO2 increase < 20 mmHg or
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Post-ductal SpO2 increased < 5%
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Maintaining iNO at 20 ppm, wean FiO2 as follows*:
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Titrate Fi02 to maintain post-ductal SpO2 94-98%
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Do not wean FiO2 > 10 % per hour
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Consider Discontinuing iNO
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25-30% of neonates will be
non-responders to iNO therapy
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When FiO2 ≤ 60%,
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Wean iNO 20 to 10
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While continuing to wean FiO2 as above, begin iNO weaning every 4 hours as tolerated
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iNO Weaning Progression
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10
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5
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3
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2
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Increase FiO2 by 10% and Turn iNO off
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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
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
Resources
- Safety of withdrawing inhaled nitric oxide therapy in persistent pulmonary hypertension of the newborn.
- Hospital variation in nitric oxide use for premature infants.
- Reducing variation in the use of inhaled nitric oxide.
- Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn.
- Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn Refractory to High Frequency Ventilation.
- Persistent pulmonary hypertension of the newborn.
- Nitric oxide for respiratory failure in infants born at or near term.