Principles of Pharmacology for Respiratory Care by Georgine Bills;Christina Rose; & Christina Rose
Author:Georgine Bills;Christina Rose; & Christina Rose
Language: eng
Format: epub
Publisher: Jones & Bartlett Learning LLC
Published: 2021-06-15T00:00:00+00:00
Adverse effects and hazards: The primary hazards of INO therapy are rebound pulmonary hypertension due to abrupt discontinuation of therapy, as previously discussed, and the development of methemoglobinemia. NO diffuses into red blood cells and when combined with hemoglobin forms methemoglobin. Both of these hazards are avoidable by using appropriate INO protocols. The lowest effective concentration of INO should be used, and even when the dosage is low, INO must be weaned and the patient supported with increased FiO2 at discontinuation. Methemoglobinemia is unlikely in therapeutic dosage ranges (less than 40 ppm) but this should be monitored. If the methemoglobin level exceeds 5%, the INO concentration should be reduced or discontinued. When NO is exposed to high concentrations of oxygen gas, nitric dioxide (NO2) is formed, which may lead to lung tissue injury and pulmonary edema. Using the lowest effective dose for the shortest time period clinically necessary is important to prevent these adverse effects.
Although not a clinical hazard, it is imperative that the RCP and all care givers exercise great caution in handling the equipment and cylinders associated with INO therapy and the INOvent to prevent waste and unnecessary expense.
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