1705 Nitric Oxide Delivery with a Novel Ventilator Circuit Connector - An In Vitro Study under Neonatal Ventilatory Conditions

Introduction PPHN is treated with inhaled nitric oxide (iNO). A novel ventilator circuit connector (NVCC, AFECTAIR®, Discovery Laboratories, Inc., Warrington, PA) has been developed to simplify the delivery of aerosols to patients receiving ventilatory support. We hypothesized that use of the NVCC for iNO delivery would substantially reduce NO consumption. Aim To compare the NVCC with the SoC in the delivery of iNO under simulated neonatal ventilator conditions. Material and Methods A pediatric/neonatal test system with Babylog® VN-500 with various inspiratory pressures, test lung, and ASL-5000 lung simulator were used. For SoC measurements, using a standard wye connector, the iNO was delivered per the manufacturer’s instructions. With the NVCC, iNO was administered by introducing the NO via a tube attached directly to the NVCC. NO concentrations were measured with a NOxBOX®+ analyzer and NO flow was recorded by Electronic Nitric Oxide flow controller abd titrated to 20 ppm at the patient interface. Results Compared with SoC, there was a 2 to 3 fold decrease in NO flow requirements to achieve desired iNO concentration with the NVCC. The delivery of O2 was not different between the study conditions. NO2 levels were slightly higher for the NVCC group, but never higher than 1.13 ppm. Conclusion The NVCC significantly decreased the NO flow required for targeted delivery of 20 ppm. The NVCC allows for simplified therapeutic gas delivery with reduced NO utilization. These results warrant further study of NVCC on compatibility assessment with various modes of ventilation and delivery of other medical gases.