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Workplace NO and NO2 during combined treatment of infants with nasal CPAP and NO

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Abstract

Objective

To determine the workplace concentrations of NO and NO2 in and around a paediatric incubator during inhaled NO (iNO) treatment and during an accidental emptying of NO cylinders into room air.

Design

We simulated iNO–nasal CPAP treatment in order to assess the impact on the occupational environment. Furthermore, two full NO cylinders for therapy, 1,000 ppm, 20 litres, 150 bar and 400 ppm, 10 litres, 150 bar, were emptied as rapidly as possible into an intensive care unit (ICU) room.

Setting

University hospital ICU.

Measurements and results

To correctly gauge the contribution from iNO–CPAP we constructed a system measuring breathing zone and room ventilation inlet-outlet values during a 10-ppm iNO treatment of a simulated infant. Maximal breathing zone values were 17.9 ± 7.0 (mean ± 95% CI) ppb for NO and 25.2 ± 4.8 ppb for NO2. If room inlet values were subtracted, the contributions to breathing zone values emanating from iNO–CPAP were 14.8 ± 4.6 ppb for NO and 14.6 ± 4.6 ppb for NO2. At the ventilation outlet the maximal contributions were 4.2 ± 2.9 ppb NO and 9.6 ± 4.3 ppb NO2. During rapid total release of a gas cylinder in the ICU room, simulating an accident, we found transient NO levels comparable to the high therapeutic dosing range, but only low NO2 levels.

Conclusions

Neither 8-h time-weighted average (TWA) nor 15 min short-term exposure limits (STEL) were exceeded during normal operation or during a simulated accident. The contribution of nitrogen oxides from treatment to workplace air were minor compared to those from ambient air.

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Acknowledgements

This study was supported by the European Space Agency, the Swedish Science Council, the Swedish Heart-Lung Foundation, Karolinska Institutet and the Stockholm County Council. INO Therapeutics (through Berit Lindh, Nordic manager) kindly provided study gases. The authors are indebted to Dr C-J. Wickerts, head of the ICU at Danderyd University Hospital, for access to ICU facilities as a setting for these studies. The author C.F. wishes to disclose a conflict of interest as he has a financial interest in the clinical use of inhaled nitric oxide, and L.G. is a minority shareholder in Aerocrine AB (publ.), a company that markets instruments for measurements of exhaled nitric oxide, and has given consultancy to gas industry concerning the use of nitric oxide.

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Authors and Affiliations

  1. Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd University Hospital, 182 88, Stockholm, Sweden

    Robert Lindwall & Mats E. Svensson

  2. Karolinska Institutet, Dept of Physiology and Pharmacology, Division of Anaesthesia and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden

    Claes G. Frostell

  3. Karolinska Institutet, Department of Woman and Child Health, Childhood Cancer Research Unit, Stockholm, Sweden

    Staffan Eksborg

  4. Karolinska Pharmacy, Karolinska University Hospital, Solna, Stockholm, Sweden

    Staffan Eksborg

  5. Department of Physiology and Pharmacology and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden

    Lars E. Gustafsson

Authors
  1. Robert Lindwall
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  2. Mats E. Svensson
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  3. Claes G. Frostell
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  4. Staffan Eksborg
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  5. Lars E. Gustafsson
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Correspondence to Robert Lindwall.

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Lindwall, R., Svensson, M.E., Frostell, C.G. et al. Workplace NO and NO2 during combined treatment of infants with nasal CPAP and NO. Intensive Care Med 32, 2034–2041 (2006). https://doi.org/10.1007/s00134-006-0393-1

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  • DOI: https://doi.org/10.1007/s00134-006-0393-1

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