Nitric Oxide, Inhaled — Weaning Goals — Clinical Pathway: ICU and Inpatient

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

Weaning Goals

iNO should be weaned as early as possible and only continued if some clinical benefit is seen (e.g. improvement in SpO2, paO2, or FiO2). RT team will discuss with medical and nursing teams readiness and subsequent steps for weaning.

 
Start:
Wean 20ppm
to 10ppm
*Tolerated?
Return to 20ppm
NO
YES
At 4 hours:
Wean 10ppm
to 5ppm
*Tolerated?
Return to 10ppm
NO
YES
At 4 hours:
Wean 5ppm
to 2ppm
*Tolerated?
Return to 5ppm
NO
YES
At 4 hours:
Increase FiO2
by 10%
Turn iNO off
*Tolerated?
Return to 2ppm
NO
After 24 hours, reattempt weaning
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Tolerating a wean is defined as:

  • ≤ 20% decrease in PaO2
  • OR
  • 5% decrease in SpO2
  • AND
  • Ability to maintain FiO2 at < 50% after wean

Note: Other lab values should not guide the decision to wean iNO. PaO2, FiO2 and SpO2 should be determinants for the ability to wean.


For those patients with presumed PHTN or cardiac dysfunction who may benefit from a slower wean:

  • Evaluate for right sided heart failure
  • Place a consult to pulmonary hypertension