To prevent an adverse rebound effect when withdrawing NO therapy, what should you do?
1. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm).
2. Hyperoxygenate the patient just before discontinuing NO.
3. Ensure that the patient is hemodynamically stable.
a. 1 and 2 only
b. 2 and 3 only
c. 1 and 3 only
d. 1, 2, and 3
ANS: D
First, the NO level should be reduced to the lowest effective dose (ideally =5 ppm). Second, the patient's condition should be hemodynamically stable, and the patient should be able to maintain adequate oxygenation while breathing a moderate FiO2 (0.4 or less) on low levels of positive end expiratory pressure. Third, the patient should be hyperoxygenated (FiO2, 0.60 to 0.70) just before discontinuation of NO inhalation.
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