Fluctuations of inspired concentrations of nitric oxide and nitrogen dioxide during mechanical ventilation

Background: Nitric oxide (NO) is a very reactive agent with potentially toxic oxidation products such as nitrogen dioxide (NO2). Therefore, during NO inhalation a constant inspired concentration and accurate measurement of NO and NO2 concentrations are essential. The objective of this study was to test the NO concentrations at various positions along the inspiratory limb of the breathing circuit using a recently developed system to administer NO in phase with inspiratory flow during mechanical ventilation (Servo 300 NO-A, Siemens, Sweden). Furthermore, we tested whether an active heating system would interfere with inspired NO concentrations.

      Results:
      A sharp decline in the NO concentration was found between the
			respirator's inspiratory outlet and more distal points along the inspiratory
			limb of the circuit. This finding was most evident when an active heating
			system was mounted between those points.
    
    
      Conclusions:
      The concentrations of NO and NO2 should be measured as
			near to the patient as possible, as significant fluctuations of these
			concentrations might be found along the inspiratory limb of the respiratory
			circuit especially when an active heating system is used.