Monitoring

Nitric oxide and nitrogen dioxide concentrations may be monitored conveniently with portable fuel cell analysers or by chemiluminescence. It is important to monitor concentrations of both gases in the inspiratory limb of the ventilator circuit. Monitoring of nitrogen dioxide is important to ensure that toxic doses are not formed with the oxygen in the inspired gas and subsequently inhaled by the patient. Although it is extremely rare to see toxic nitrogen dioxide concentrations (>5ppm) it is possible to remove nitrogen dioxide from the inspired gas by using a soda lime adsorber. Methaemoglobin is formed when nitric oxide binds to haemoglobin. Prolonged inhalation at higher doses may rarely produce significant methaemoglobinaemia (>5%) and this should therefore be monitored daily.

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