This Article Full Text Full Text (PDF) All Versions of this Article: 200306-784OCv1 168/10/1210    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Törnberg, D. C. Articles by Weitzberg, E. Search for Related Content PubMed PubMed Citation Articles by Törnberg, D. C. Articles by Weitzberg, E.

Multiple Single-breath Measurements of Nitric Oxide in the Intubated Patient

Department of Anesthesiology and Intensive Care, Karolinska Hospital, and Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

Correspondence and requests for reprints should be addressed to Daniel C. Törnberg, M.D., Department of Anesthesiology and Intensive Care, Karolinska Hospital, S-171 76 Stockholm, Sweden. E-mail: danieltornberg{at}hotmail.com

Multiple flow rate measurements of exhaled nitric oxide (NO) have been advocated to fractionate NO from alveolar and bronchial sources. The aim of this study was to develop a method by which multiple single-breath exhalations at various flow rates could be performed in intubated, mechanically ventilated patients. Nine patients without lung disease were studied awake and after intubation, during general anesthesia. A suction ejection system connected to a restrictor valve was used to control the exhalation flow rate. From these measurements the fraction of alveolar NO (FA_NO), the fraction of airway wall NO (Faw_NO), and the airway wall transfer rate (D_NO) were calculated. The fraction of exhaled NO was reduced by 50% after intubation. D_NO was also reduced by intubation (from 10 ± 1.3 to 6.4 ± 2.1 nl second^-1 ppb^-1 x 10^-3) whereas neither Faw_NO nor FA_NO was affected. The peak NO concentration after 20 seconds of apnea during general anesthesia was similar to calculated Faw_NO. The vacuum aspiration method used in this study allowed for reproducible multiple single-breath measurements and calculation of alveolar and bronchial NO parameters. Further studies will reveal whether this methodology will improve the value of exhaled NO analysis in intubated, mechanically ventilated patients with pulmonary disease.

Key Words: exhaled • lung function • mechanical ventilation • pulmonary

This article has been cited by other articles:

				A. Malinovschi, C. Janson, T. Holmkvist, D. Norback, P. Merilainen, and M. Hogman Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters Eur. Respir. J., August 1, 2006; 28(2): 339 - 345. [Abstract] [Full Text] [PDF]

				ATS Workshop Proceedings: Exhaled Nitric Oxide and Nitric Oxide Oxidative Metabolism in Exhaled Breath Condensate: Executive Summary. Am. J. Respir. Crit. Care Med., April 1, 2006; 173(7): 811 - 813. [Full Text] [PDF]

				R. Zegdi and J.-N. Fabiani Exhaled Nitric Oxide After Cardiopulmonary Bypass Ann. Thorac. Surg., November 1, 2005; 80(5): 1977 - 1977. [Full Text] [PDF]

				P. E. Silkoff Monitoring nitric oxide: here to stay for bench and bedside Eur. Respir. J., June 1, 2005; 25(6): 949 - 950. [Full Text] [PDF]

				ATS/ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005 Am. J. Respir. Crit. Care Med., April 15, 2005; 171(8): 912 - 930. [Full Text] [PDF]

				D. C. Tornberg, M. Angdin, G. Settergen, J. Liska, J. O. Lundberg, and E. Weitzberg Exhaled nitric oxide before and after cardiac surgery with cardiopulmonary bypass--response to acetylcholine and nitroglycerin Br. J. Anaesth., February 1, 2005; 94(2): 174 - 180. [Abstract] [Full Text] [PDF]

				P. Condorelli, H.-W. Shin, and S. C. George Characterizing airway and alveolar nitric oxide exchange during tidal breathing using a three-compartment model J Appl Physiol, May 1, 2004; 96(5): 1832 - 1842. [Abstract] [Full Text] [PDF]

				M. J. Tobin Critical Care Medicine in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 239 - 253. [Full Text] [PDF]

				M. J. Tobin Asthma, Airway Biology, and Nasal Disorders in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 265 - 276. [Full Text] [PDF]