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Nitric Oxide Use and alternatives

By Greg Merritt posted 11-06-2014 11:30

  
I wanted to reach out to other facilities that are using Nitric Oxide. The use of this gas continues to be a growing concern due to the aggressive price increases of the company. I know there was some discussion about 12th man, but I have not heard anything within the past 2 years. We are looking for alternatives to delivering this expensive therapy. Has anyone had success with decreasing the use of nitric oxide? If so would you mind sharing your success? I have experience with the use of Flolan and Illiprost (inhaled,) but that is a tough sell for the physicians.
Respectfully,
    Greg Merritt
    Clinical Educator
    Medical City Children's Hospital
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Comments

Wendy Castro MS, RRT, RRT-NPS
02-18-2017 16:37

Hi Greg! 

We have a Valetri protocol that we will soon use via Aerogen and IV pump. 
I responded to someone recently in the Neo/Pedi section with the protocol and education. We will be measuring cost and duration of therapy in comparison to 2016. My work email is wendy.castro@providence.org. Let me know if you want me to send it via email.

Holly Tull
03-11-2016 14:24

We don't use NO, but my medical director want to start using it to test patients for responsiveness to NO tx. Would any of you be willing to share your protocols, types/Brands of equipment you use to deliver it, and is there a special NO mix that needs to be purchased through our gas vendors?

Scott Lofland
12-22-2014 10:43

Greg:
This is an issue that my previous facility has addressed for the last several years now. Like Hope mentioned, we have produced specific protocols for the time management of INO, which has been implemented in both the Neonatal and Adult arenas. We have not found a suitable substitute drug or process. At $140 plus dollars per hour, NO is very expensive to use, with no available alternatives other than Iloprost or Flolan as you suggested. The key right now is time management of INO use.

Hope Sellon
12-01-2014 03:04

One thing that our department has done is establish a protocol to wean NO more rapidly to help decrease overuse and bring down costs. We have a protocol for the adult side that has helped, the pediatric side is working on a policy I believe. But we haven't found a more effective medication that I am aware of. NO is the one we primarily use.

Bill Cohagen
11-11-2014 10:34

Greg.,
I am in the same boat as you. We really need some alternatives to this not only because of the high cost, but because of the low use and keeping staff sharp on this procedure is a safety concern that my Neonatologists ignore.