Achieving the correct dose

Approximately 50% of patients with severe respiratory failure respond to nitric oxide. However, the most effective dose varies. It is usual to start at 1ppm for 10min and monitor the change in PaO2/FIO2 ratio. An increase should be followed by an increase in nitric oxide concentration to 5ppm for a further 10min. Thereafter, the dose is adjusted according to response at 10min intervals until the most effective dose is found. Since the underlying pathophysiology may change, it is important to assess the dose response at daily intervals, aiming to keep the dose at the lowest effective level.

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