Electrochemically Generated Inhaled Nitric Oxide (iNO) delivery via High Flow Nasal Cannula (HFNC)

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"Electrochemically Generated Inhaled Nitric Oxide (iNO) Delivery via High Flow Nasal Cannula (HFNC)” Abstract Patients with COVID-19 or other severe respiratory tract infections often develop acute hypoxemic respiratory failure. Improving the oxygenation of these patients is critical for improving outcome. As a selective pulmonary vasodilator, inhaled nitric oxide (iNO) has already become a mainstay of intensive care units for lung failure to improve oxygenation and it is also a very potent antiseptic agent. Delivering iNO via a noninvasive high flow nasal cannula (HFNC) method can potentially obviate the need for, and reduce the risks associated with, invasive mechanical ventilation. We hypothesize that the NO levels delivered with HFNC reaching the deep lung - where NO has its pharmacological effect - would be significantly greater and better controlled than NO delivered via low flow nasal cannula. However, the costs of current iNO technologies are prohibitive for use in high flow inhalation therapy. These costs are associated with the long-term instability of NO and the limited payload of conventional NO gas cylinders in which NO must be stored at low concentrations (up to 800 ppm) to prevent disproportion reactions. We have developed a safe and very cost-effective electrochemical method for on-demand generation of pure NO from stable solutions of inorganic sodium nitrite for medical applications. We now propose to combine this novel technology with HFNC delivery and demonstrate the feasibility of this new technology for safe and inexpensive delivery of iNO to the lungs at therapeutically relevant levels via a nasal cannula. If successful, this technology can potentially shift the paradigm of iNO therapy in healthcare settings and could be used to better treat respiratory distress caused by viral or bacterial infections, such as in COVID-19.