The NO-A has different operating and dosing modes which enable a combination with almost any ventilator. Besides the manual operation, which enables the user to adapt the therapy to a wide spectrum of ventilation situations by adjusting the ventilation flow independently, the NO-A offers two other operating modes which automatically adjust to the conditions in the ventilation circuit with the ventilator interface and a flow sensor.

The dosing modes differ from continuous and triggered dosing mode. An optional third mode even allows the operation in semi-closed systems of anaesthesia units by a dosimetric procedure (currently only available in Germany).

Currently available ventilator interfaces:

Getinge (MAQUET) 


Dräger

Hamilton Medical


Löwenstein Medical


*  Compatibility depends on ventilator SW/HW version.

** Dosing mode depends on ventilator mode.

Already known settings with flow sensor:

Dosing modes:

With this dosing method the therapy gas is supplied in continuously clocked cycles to the ventilation by knowing the MVi-value and a "quasi-continuous" dosing is achieved by the time in the inspiratory path of the breathing circuit. This dosing method is also found in the NO-A's secondary dosing system.

The triggered dosing of NO-A applies the corresponding amount of therapy gas by analysing the available flow curves with the approach to achieve a "flow-proportional" NO-dosing and thus to receive a constant NO-concentration in the inspiratory tube even with varying flows.

Performances of iNO-therapy are based on the continuous availability of the drug in the inspiratory breathing flow/respiratory gas stream. The effect of the drug is linked to the NO-molecule in the interaction of the muscle cell, not to the concentration at the patient tube. A bolus-wise dosing is therefore a dosimetric procedure which doses a proportional volume of nitric oxice (iNO) referring to the tidal volume at the beginning of each breath.

dosimetric application

For this the nitric oxide has to be led in at the Y-piece close to the patient. Compared to the conventional dosing methods the dosimetric application in a bolus offers the advantage of transporting the drug to the target cells in a more controlled way with simultaneous minimisation of the contact time between nitric oxide and the oxygen existing in the respiratory gas. The shorter the contact time, the less nitrogen dioxide is produced as toxic conversion product. Furthermore this dosing method enables to reduce the consumption of therapy gas significantly, as only actually applied respiratory volume has to be enriched with nitric oxide.