PICU Clinical Pathway for Use of Inhaled Nitric Oxide for Management of Children with Acute Hypoxemic Respiratory Failure
- Related Pathway
Child in the PICU Requiring Inhaled Nitric Oxide (iNO) for Hypoxemic Respiratory Failure
Exclusion Criteria
Primary pulmonary hypertension
Primary pulmonary hypertension
RT Document Baseline Data
Ventilator settings
OI/PF Ratio
Pre-iNO ABG
Initiate iNO
Preferred to maintain current ventilator settings, FiO2
After 30 mins repeat ABG
Adverse cardiorespiratory effects felt to be due to iNO
Discontinue iNO
Responsive to iNO
PaO2 increase ≥ 20%
or
SpO2 increase ≥ 5%
Not Responsive to iNO
PaO2 increase < 20%
and
SpO2 increase < 5%
Maintain iNO at 20 ppm
Wean FiO2 to < 50% as able
Discontinue iNO
FiO2 < 50% for 4 hrs
- RT discuss with medical and nursing teams appropriateness of iNO weaning
- Provider orders Critical Care Inhaled Nitric Oxide Weaning Clinical Pathway Started
Wean iN0 20 ppm to 10 ppm
- iNO Weaning Progression
Wean q4hr as tolerated -
10 ppm5 ppm
-
5 ppm2 ppm
- Increase FiO2 by 10%
Turn iNO off
Return to previous iNO level
Resume wean after 4 hrs
Evidence
- Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference
- Inhaled Nitric Oxide Does Not Reduce Mortality in Patients With Acute Respiratory Distress Syndrome Regardless of Severity
- Weaning of Inhaled Nitric Oxide: Is There a Best Strategy?
- A Quality Improvement Initiative to Standardize Use of Inhaled Nitric Oxide in the PICU
- Pediatric Acute Respiratory Distress Syndrome: Consensus Recommendations From the Pediatric Acute Lung Injury Consensus Conference