As of December 2002, Vanderbilt acquired the capacity to treat neonates with iNO during transport. 

Infants who are candidates for iNO during transport include:

1.)    Infants with PPHN or CHD being treated with iNO by the referring institution and being transferred for ECMO SHOULD NOT have iNO discontinued even if the infant’s response seemed minimal as sudden discontinuation can lead to acute decompensation with hypoxemia.  All infants on iNO at the referring institution should be transported to Vanderbilt on iNO.

2.)    Term and near-term infants who, upon discussion with the referring physician, the neonatology fellow or attending feel have a likely diagnosis of PPHN and might benefit from earlier administration of iNO when the team arrives and in transport.

For all transports in which the patient will be treated with iNO en route, a respiratory therapist must accompany the usual Angel transport team of NNP, neonatal nurse, and driver/assistant.  Therefore, the potential need for iNO on transport must be identified with the initial dispatch.  When the accepting neonatology fellow or attending notifies the LifeFlight dispatcher that iNO should be available on the transport, Flightcomm will page the RRT in addition to the usual transport and call team members.

Currently inhaled NO can only be provided during ground transports by the Angel team, NOT during LifeFLight helicopter transports due to a lack of room for necessary personnel in the helicopter.  Med Center Air does have the capacity to transport infants on iNO by fixed wing.

During a transport it remains important to ensure adequate alveolar recruitment with mechanical ventilation and surfactant therapy before the institution of iNO for optimal effect.  Inhaled NO should be initiated at 20 ppm and not weaned during transport.  Adequate sedation and other standard therapies for PPHN should continue to be administered.  A methemoblogin level does not need to be drawn by the transport team; it may be drawn later, 4- 8 hours after the initiation of iNO.

Approved at the Regionalization and Transport meeting 12/18/02.