Vol. 29 No. 1 (2025)
REVIEWS

Nitrogen dioxide as a by-product of inhaled nitric monoxide therapy. Concentration in the inhaled gas mixture acceptable in clinical practice. A systematic review

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  • A.E. Bautin,
  • I.G. Chomakhashvili,
  • K.Yu. Afanasyeva,
  • A.O. Marichev,
  • A.M. Radovskiy,
  • D.A. Kozyrev,
  • E.K. Barygin,
  • G.N. Ablesimov,
  • N.V. Badalyan,
  • M.S. Zhuravleva,
  • A.M. Pozhidaeva,
  • A.A. Burov,
  • Yu.V. Valueva
A.E. Bautin
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
I.G. Chomakhashvili
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
Bio
K.Yu. Afanasyeva
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
A.O. Marichev
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
A.M. Radovskiy
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
D.A. Kozyrev
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
E.K. Barygin
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
G.N. Ablesimov
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
N.V. Badalyan
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
M.S. Zhuravleva
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
A.M. Pozhidaeva
Almazov National Medical Research Center, Ministry of Healthcare of the Russian Federation, Saint Petersburg
A.A. Burov
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, Moscow
Yu.V. Valueva
Mendeleev University of Chemical Technology, Moscow
DOI: https://doi.org/10.21688/1681-3472-2025-1-61-74

Published 2025-04-28

Keywords

  • Newborn,
  • Nitric Oxide,
  • Nitrogen Dioxide,
  • Pulmonary Hypertension

How to Cite

Bautin, A., Chomakhashvili, I., Afanasyeva, K., Marichev, A., Radovskiy, A., Kozyrev, D., Barygin, E., Ablesimov, G., Badalyan, N., Zhuravleva, M., Pozhidaeva, A., Burov, A., & Valueva, Y. (2025). Nitrogen dioxide as a by-product of inhaled nitric monoxide therapy. Concentration in the inhaled gas mixture acceptable in clinical practice. A systematic review. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 29(1), 61–74. https://doi.org/10.21688/1681-3472-2025-1-61-74

Copyright (c) 2025 Bautin A.E., Chomakhashvili I.G., Afanasyeva K.Yu., Marichev A.O., Radovskiy A.M., Kozyrev D.A., Barygin E.K., Ablesimov G.N., Badalyan N.V., Zhuravleva M.S., Pozhidaeva A.M., Burov A.A., Valueva Yu.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Objective: The study aimed to review the literature data on the recommended maximum concentrations of nitrogen dioxide during inhaled therapy with nitric oxide and to propose a general list of recommendations on safe therapy with inhaled nitric oxide.

Methods: The systematic review was performed according to the PRISMA 2020 criteria. A search was carried out in databases Russian Science Citation Index, MedLine, Cochrane Library using the keywords “nitrogen dioxide”, “limit concentration”, “annual limit value”, “inhaled nitric oxide”.

Results: The review included 28 articles, 20 sources from regulatory authorities setting hygiene standards, and 2 instructions for devices.

Conclusion: For short periods of NO inhalation not exceeding one hour, the maximum permissible concentration of NO2 in the inhaled gas mixture may be defined as 5 ppm. In cases of NO inhalation not exceeding 24 hours, the maximum permissible concentration of NO2 in the inhaled mixture should be considered as 2 ppm. If the duration of NO inhalation exceeds 24 hours, the permissible concentration of NO2 in the inhaled gas mixture should be limited to 1 ppm.

Received 29 November 2024. Revised 9 January 2025. Accepted 13 January 2025.

Funding
This research was carried out within the state assignment “Development of a new device for supplying nitric oxide synthesized from atmospheric air into mechanical circulatory assist devices” No. 123021000129‑1.

Conflict of interest
The authors declare no conflict of interest.

Contribution of the authors
Conception and study design: A.E. Bautin, A.A. Burov, Yu.V. Valueva
Data collection and analysis: I.G. Chomakhashvili, K.Yu. Afanasyeva, D.A. Kozyrev, E.K. Barygin, G.N. Ablesimov, N.V. Badalyan, M.S. Zhuravleva, A.M. Pozhidaeva, A.A. Burov, Yu.V. Valueva
Drafting the article: I.G. Chomakhashvili, A.A. Burov, Yu.V. Valueva
Critical revision of the article: A.E. Bautin, A.O. Marichev, A.M. Radovskiy, A.A. Burov
Final approval of the version to be published: A.E. Bautin, I.G. Chomakhashvili, K.Yu. Afanasyeva, A.O. Marichev, A.M. Radovskiy, D.A. Kozyrev, E.K. Barygin, G.N. Ablesimov, N.V. Badalyan, M.S. Zhuravleva, A.M. Pozhidaeva, A.A. Burov, Yu.V. Valueva

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