Skip to main content

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

PICU Clinical Pathway for Use of Inhaled Nitric Oxide for Management of Children with Acute Hypoxemic Respiratory Failure

Child in the PICU Requiring Inhaled Nitric Oxide (iNO) for Hypoxemic Respiratory Failure

 
 
Exclusion Criteria
Primary pulmonary hypertension

Criteria for Initiating iNO

P/F Ratio < 100
or
Oxygen Index > 15
 
 

RT Document Baseline Data
Ventilator settings
OI/PF Ratio
Pre-iNO ABG

 
 

Initiate iNO
Preferred to maintain current ventilator settings, FiO2

Initiate iNO at 20 ppm
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 ppm
     
     
    5 ppm
  • 5 ppm
     
     
    2 ppm
  • Increase FiO2 by 10%
     
     
    Turn iNO off

Return to previous iNO level
Resume wean after 4 hrs

 

Jump back to top