Doctor explains: when to use Nitric Oxide in Pulmonary Hypertension
ฝัง
- เผยแพร่เมื่อ 9 ก.ค. 2024
- We've all seen the MAGIC of Inhaled Nitric Oxide at bedside, but how does it work? And how did anyone figure it out? We go over its mechanism of action (and how does viagra/ sildenafil work differently), its side effects, what dosage we use and plenty of other clinically relevant aspects of the gas.
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Warren M. Zapol; Nitric Oxide Story. Anesthesiology 2019; 130:435-440 doi: doi.org/10.1097/ALN.000000000...
Sherlock LG, Wright CJ, Kinsella JP, Delaney C. Inhaled nitric oxide use in neonates: Balancing what is evidence-based and what is physiologically sound. Nitric Oxide. 2020 Feb 1;95:12-16. doi: 10.1016/j.niox.2019.12.001. Epub 2019 Dec 19. PMID: 31866361; PMCID: PMC7594166.
Barrington KJ, Finer N, Pennaforte T. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev. 2017 Jan 3;1(1):CD000509. doi: 10.1002/14651858.CD000509.pub5. PMID: 28045472; PMCID: PMC6464861.
Peliowski A; Canadian Paediatric Society, Fetus and Newborn Committee. Inhaled nitric oxide use in newborns. Paediatr Child Health. 2012 Feb;17(2):95-100. doi: 10.1093/pch/17.2.95. PMID: 23372402; PMCID: PMC3299357.
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**TIMESTAMPS**
00:30 History of iNO
09:11 How does iNO work?
11:26 Side effects of iNO
14:31 How is iNO given?
16:21 When do you start iNO?
19:34 What dose of iNO do we give?
21:31 When else do we give iNO?
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
best teacher i have ever come across.Thank you Dr Tala, i am watching you from zambia
This comment made my week! Thank you so much- and so happy you're watching all the way from Zambia :)
Zambia 🇿🇲 yahhh!! She is a great teacher.
I'm equally watching from Zambia 🇿🇲
I am respiratory therapist and I really like your way of teaching .. I learned a lot today
That's so great - thank you for the lovey compliment- I'm so glad RTs watching too. There's so much vent stuff we want to cover- so I'm really hoping an RT friend of mine will help!!!
New-ish RT here starting in the NICU 🙋🏻♀️ been loving your videos and how they break down these topics school didn’t have the time to cover (thank you for always shouting us out! 🥲)
I’m sure you more than likely already know but for anyone who doesn’t… the iNO machine most places have has a place to attach the ambu bag to continue iNO while bagging! You/the RT just has to make sure the dial on the front matches the amount that was being given before bagging ☺️
I was hoping you could cover the differences between the oscillator vs the jet if you haven’t yet! Just being told active vs passive ventilation isn’t as helpful as people think it is 😅
Hello! So happy you’re in the unit! Yes! Took me time to figure it out- they’re tricky those portholes! Thank you! Would be great to do a video on logistics like that! And yes! Hahaha the active vs passive thing- such a textbook- almost meaningless answer!!! We made a video on oscillators- and we’re filming the one in jets soon!!! Thank you!
Using iNO on a 25 wkr right now. ~400g, 100% O2. severe R -> L shunt. With NO we got her down to mid 30's. I flew with a cooling, HFOV NO infant not long back. She needed ECMO int he worst way. Severe MAS. This was a wonderful overview of the logic of iNO in these populations. Thank you. I learned a lot.
So glad you enjoyed it. Crazy how iNO sometimes randomly helps babies and sometimes it's useless. God bless you for transporting these babies- such a difficult stressful job. Thanks so much for being here!
Thank you so much for simplifying complex concepts.
WE're so glad you think so! Thank you!
Brilliant as always Dr Tala. Thank you!
Ohh. thank you so much- you're such a good motivator - we appreciate you so much!
This is splendid! Honestly, I am a type of person who just skips the history part of any topic but today I enjoyed every second and was able to listen for more. Also, I would like to comment on the quality of this video as it is clear that there was a huge effort to bring it to this level. Thanx Dr. Tala
OH THANK YOU! we're trying! We realize at some stage we need to make the leap to a more professional production- but we seem to be eking by now with small improvements- so I'm glad you noticed a difference!
And I'm with you- sometimes the history of something is so irrelevant ("in 1807...blah blah") but there's something about neonatal history- and how we got here. (So I can't take credit for that- the story is just fascinating!). Thank you again for being here :)
Another great video!!!
THANK YOU- as always :)
Thank you for this !
You’re so welcome! Thanks for watching :)
Keep it up it with the good work...i understood the pathophysiology PPHN because of your simplified explanation...am from zambia too pursuing my bachelor in pharmacy
Thank you Dr. Tala. This really helps to understand the PPHN treatment. I am from Canada.
That's fantastic! Stay warm!!!
The best teacher ! keep it up
Not sure if I deserve that compliment- but thank you so much Dr. Mame. So happy you're watching :)
I was scared of the complex topics like hfov, pphn but you have made it really easy to understand.. many thanks. ❤From India
That makes us SO happy!!! Thank you so much for being here and for taking the time to comment :)
Brilliant talk on iNO. Thank you so much.
Oh thank you! We’re so glad you think so- wish I could take more credit but was such a brilliant article!!!
thanks for your effort to teach
Thank you so much for following and watching- appreciate your support :)
Thank u for the great videos! Suggesting one on DIC syndrome... please
Thanks for the great suggestion Keelan- we didn't have that one down. (In the meantime maybe check out the video we made on coagulation factors- may help a little). THANKS!
Thank you so much Dr Tala. G’Day from Darwin Australia 😊
I just read that out to my kids at breakfast and made our morning! Thank you!
Thank u dr tala please keep going to provide us more videos
Thank you so much for being here and taking the time to write! Our plan is to continue indefinitely! Fingers crossed!
Thank you Dr.Tala
Thank you for being here!
You are brilliant ❤️
Definitely not! But thank you for the lovely comment!
Thank you doctor Tala
Thanks for watching!
Thank you
Thank you for watching!
Very well explained, take away is the 20, 20, 20 rule
Yes! Thanks so much!
Excellent coverage of the topic! I am a nursing student from California. Your explanations of caffiene, NO, and sildenafil use in the NICU are so helpful! Can you cover more NICU meds, please?
Thank you SO much Summer (not sure if that's your name!)- for your comment and for subscribing. What do you think would be most helpful from a medication standpoint? Like a specific med- or more generalities about dosing and drips and stuff?
@@TalaTalksNICU It would help to know when the meds are used, neonatal specific considerations for administration, any special precautions, etc.
@summerrejmankova1491 yes! That sounds like a great idea for a video! Thank you so much!
Can you do a video on some of the uses of IVIG in the NICU?
That is SUCH a great suggestion Chris- thanks so much!
Plz do a vedio regarding cooling
We did! If you go to the home page- and look up the HIE and hypothermic therapy videos- you'll find them. Hopefully that covers the information you're interested in? Thanks for being here!
Can you talk about neonatal sepsis please
SO happy you asked for this- its our next video series coming out :)
Really awesome video, love it unfortunately its not available in my country at present but it really great to learn, thanks again to you and your team
Oh no! Where exactly are you and in what capacity are you working? I didn't realise this at all- and yet you are our most ardent supporter! Thank you so much!
@@TalaTalksNICU Hi, yes it’s unfortunate, am in guyana its a small South American country the Pediatrics and Neonatology service are in development it has vastly improved in the last 10 years but lots more for improvement, currently only 1 Nicu in the capital and about 3 satellite nicu in the other areas so we have lots of work always
That’s so amazing that you’re there and helping to build the program. What a satisfying job in a beautiful country it must be. If there is a way I can send you videos I can try?
Is there any contraindications for iNO?
well- really no on paper. If you have methemoglobinemia this would be a bad idea (but why would a baby have this? lidocaine overdose?!) it is expensive and it is difficult to set up- and by the time a baby needs it, the baby is really sick, so it can be argued it shouldn't be used in lower level units (unless as a bridge to get baby transferred out).
If the lungs are collapsed or there is an actual obstruction then the iNO won't reach the alveoli so it would be useless. But essentially- it doesn't really have a lot of side effects- so you can try it- and if there is no difference in an hour or so- you can d/c it.
🎉🎉🎉
Thanks!!!!
Does nitric oxide take the place of curosurf? If yes, why? And if no, why? Thank you!
Not really...curosurf used for replacing surfactant in babies that don't have it (e.g. premature RDS babies), or in babies that have it but the surfactant has been inactivated by another substance (e.g. blood or meconium). iNO is used when the pressure in the lungs is high- normally from one of these underlying issues. Does that make sense?
Keep it up it with the good work...i understood the pathophysiology PPHN because of your simplified explanation...am from zambia too pursuing my bachelor in pharmacy
Thank you SO much! So happy you’re watching all way from Zambia :)