Exposure of intensive care unit nurses to nitric oxide and nitrogen dioxide during therapeutic use of inhaled nitric oxide in adults with acute respiratory distress syndrome.

Abstract

BACKGROUND:

Although low concentrations of inhaled nitric oxide may by therapeutic, both nitric oxide and its oxidation product nitrogen dioxide are potentially toxic. The threshold limits for time-weighted average concentrations of nitric oxide and nitrogen dioxide issued by the American Conference of Governmental Industrial Hygienists are 25 and 3 ppm, respectively. The concentrations of these gases in the breathing space of hospital personnel during administration of nitric oxide to adult patients have not been reported.

METHODS:

Air was sampled from the breathing zone of intensive care unit nurses via collar-mounted tubes during the nurses' routine duties attending patients who were receiving inhaled nitric oxide at 5 or 20 ppm. The exhaust ports of the mechanical ventilators were left open to the room. Nitric oxide and nitrogen dioxide were chemically assayed as nitrite from sorbent tubes by using spectrophotometry. Ambient nitric oxide levels were measured at sequential distances from the ventilator by using chemiluminescence.

RESULTS:

The time-weighted average concentrations of inspired gas for nurses during inhaled nitric oxide treatment were 0.45 ppm or less for nitric oxide and less than 0.29 ppm for nitrogen dioxide. Nitric oxide levels at the ventilator during delivery at 20 ppm were 9.2 ppm, but dropped off markedly beyond 0.6 m (2 ft), to a mean of about 30 ppb.

CONCLUSION:

Inhaled nitric oxide therapy at doses up to 20 ppm does not appear to pose a risk of excessive occupational exposure to nitric oxide or nitrogen dioxide to nurses during routine delivery of critical care.

• Authors: Mohammed A Qureshi, Nipurn J Shah, Carol W Hemmen, Mary C Thill, James A Kruse
• Journal: American journal of critical care : an official publication, American Association of Critical-Care Nurses (Am J Crit Care) Vol. 12 Issue 2 Pg. 147-53 (Mar 2003) ISSN: 1062-3264 [Print] United States
• PMID: 12625173 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Air Pollutants, Occupational
• Nitric Oxide
• Nitrogen Dioxide

Topics

• Administration, Inhalation
• Air Pollutants, Occupational (analysis)
• Environmental Monitoring
• Humans
• Intensive Care Units
• Nitric Oxide (administration & dosage, analysis)
• Nitrogen Dioxide (analysis)
• Occupational Exposure
• Respiratory Distress Syndrome (drug therapy, nursing)