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Published ahead of print on August 19, 2003, doi:10.1164/rccm.200306-784OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 10, November 2003, 1210-1215

A more recent version of this article appeared on November 15, 2003
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Submitted on June 13, 2003
Accepted on August 18, 2003

Multiple single breath measurements of nitric oxide in the intubated patient

Daniel C Tornberg1*, Hakan Bjorne1, Jon O Lundberg2, and Eddie Weitzberg1

1 Anesthesiolgy and Intensive Care, Karolinska Hospital, Stockholm, Sweden, 2 Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

* To whom correspondence should be addressed. E-mail: daniel.tornberg{at}hotmail.com.

Recently, 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 exhalation flow rate. From the measurements fraction of alveolar NO (FANO), fraction of airway wall NO (FWNO) and airway wall transfer rate (DNO) were calculated. Fraction of exhaled NO was reduced by 50 % after intubation. DNO was also reduced by intubation (from 10±1.3 nL s-1 ppb-1 10-3 to 6.4±2.1 nL s-1 ppb-1 10-3) while neither FWNO nor FANO were affected. Peak NO concentration after 20 s of apnea during general anesthesia was similar to calculated FWNO. 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 if this methodology will improve the value of exhaled NO analysis in intubated, mechanically ventilated patients with pulmonary disease.
Key words: pulmonary, lung function, mechanical ventilation, exhaled, inflammation




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