METHOD AND APPARATUS FOR SCAVENGING PLASMA FREE HEMOGLOBIN

1 . A method of improving hemodynamics comprising:

identifying a mammal having or at risk of developing a vascular depletion of nitric oxide due to nitric oxide scavenging by oxyhemoglobin;

positioning a mammal for nitric oxide treatment;

administering nitric oxide for aiding conversion of oxyhemoglobin to methemoglobin;

preventing scavenging effects of oxyhemoglobin; and

introducing the nitric oxide into the mammal's circulation.

2 . The method of claim 1 further comprising

mixing a first gas including oxygen and a second gas including a nitric oxide-releasing agent within a receptacle to form a gas mixture, wherein the receptacle includes an inlet, an outlet and a reducing agent; and

contacting the nitric oxide-releasing agent in the gas mixture with the reducing agent to generate nitric oxide.

3 . The method of claim 1 further comprising sedating the mammal.

4 . The method of claim 3 wherein sedating includes subjecting the mammal to anesthesia.

5 . The method of 1 , further comprising monitoring oxygen saturation levels.

6 . The method of 1 , wherein the nitric oxide is inhaled nitric oxide.

7 . The method of 1 , wherein administering the nitric oxide includes introducing nitric oxide into a respiratory breathing circuit.

8 . The method of claim 1 wherein nitric oxide is administered up to 8 ppm.

9 . The method of claim 1 wherein nitric oxide is administered up to 0.8 ppm.

10 . The method of claim 1 wherein nitric oxide is administered up to 0.08 ppm.

11 . The method of claim 1 wherein nitric oxide is administered after a first transfusion.

12 . The method of claim 1 , wherein the nitric oxide is administered during an exchange transfusion.

13 . The method of claim 1 , further comprising delivering a hydrogen gas.

14 . The method of claim 13 , wherein the hydrogen acts to eliminate peroxynitrite, thereby reducing adverse effects of nitric oxide.

15 . The method of claim 12 , further comprising delivering a subsequent transfusion.

16 . The method of claim 1 , further comprising culturing red blood cells to detect contamination prior to transfusion.

17 . The method of claim 1 , wherein nitric oxide is administered in an amount effective to prevent systemic vasoconstriction.

18 . The method of claim 1 , wherein nitric oxide is administered in an amount effective to prevent pulmonary vasoconstriction.

19 . The method of claim 1 , wherein the concentration of nitric oxide in the gas mixture delivered is at least 0.1 ppm.

20 . The method of claim 1 , wherein the concentration of nitric oxide in the gas mixture delivered is up to 5 ppm.

21 . The method of claim 1 , wherein the method includes exchanging 65 to 85 percent blood volume over a period of 2-12 hours.

22 . The method of claim 1 , wherein the circulation has estimated circulating blood volume of 80 ml/kg for term babies.

23 . The method of claim 1 , wherein the circulation has estimated circulating blood volume of 100 ml/kg for preemies.

24 . The method of claim 1 , further comprising exchanging the same percent blood volume over the same period of time in a transfusion.

25 . The method of claim 1 , further comprising monitoring calcium (Ca) levels in the mammal during transfusion, and if Ca<0.7 mEq, providing emergency treatment for hypocalcemia at 10 ml CaCl in 50-100 ml D5W given IV over 5 to 10 minutes.

26 . The method of claim 1 , further comprising monitoring potassium levels in the mammal during transfusion, and if K>6.5, administering 10-15 units IV of regular insulin along with 50 ml D50W, plus/minus 10-20 mg salbutamol by nebulization, and calcium in the presence of malignant cardiac arrhythmias.

27 . The method of claim 1 , wherein the circulation has elevated circulating cell-free hemoglobin due to acute or chronic hemolysis.

28 . The method of claim 1 , further comprising administering analgesia.

29 . The method of claim 4 , wherein level of anesthesia is evaluated continuously.

30 . The method of claim 1 , wherein the transfusion involves stored blood, greater than 7 days old.

31 . The method of claim 1 , wherein the transfusion involves fresh blood, no more than 7 days old.

32 . The method of claim 1 , wherein hydrogen gas is combined with the nitric oxide in a breathing gas.

33 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize acute renal injury.

34 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the neuroprotective effect in the brain.

35 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect in the lungs.

36 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect in the heart.

37 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect in the liver.

38 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect during cardiac injury, hepatic injury pulmonary injury, or a combination of such injuries.

39 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect during preeclampsia and hemolysis.

40 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect during disseminated intravascular coagulopathy (DIC).

41 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect during transplantation or organ preservation during support with mechanical circulatory support devices.

42 . The method of claim 41 , wherein the support devices include left, right, or biventricular assist devices, during extracorporeal membrane oxygenation (ECMO), and cardiopulmonary bypass procedures.

43 . The method of claim 1 , wherein the nitric oxide is provided in an effective amount to minimize hemolysis during sepsis.

44 . A system for improving hemodynamics comprising

a table for positioning a mammal to receive nitric oxide treatment;

a monitor configured to detect oxygen saturation levels;

a device for administering nitric oxide in an amount and frequency effective to convert oxyhemoglobin to methemoglobin in the mammal's circulation and prevent scavenging effects of oxyhemoglobin, the device including a cartridge to convert nitric oxide-releasing agents to NO, the cartridge including an inlet, an outlet, and a reducing agent.

45 . The system s of claim 44 , further comprising a sedation source.

46 . The system of claim 45 , wherein the sedation source includes anesthesia.

47 . The system of claim 44 , further comprising an analgesia source.

48 . The system of claim 44 , wherein the cartridge is configured to utilize the whole surface area in converting nitric oxide-releasing agents to NO.

49 . The system of claim 44 , wherein the reducing agent is ascorbic acid.

50 . The system of claim 44 , further comprising a transfusion device.

51 . The method of claim 1 , further comprising administering exogenous NO to modulate the hormesis characteristics of NO.

52 . The method of claim 1 , wherein the nitric oxide is administered to neonates.

53 . The method of claim 1 , wherein the nitric oxide is administered to pediatric patients.

54 . The method of claim 1 , wherein the nitric oxide is administered to adults.

55 . The method of claim 1 , wherein the nitric oxide is provided in an amount effective to minimize loss of the protective effect during transplantation and organ preservation, during support with mechanical circulatory support devices.

56 . The method of claim 41 , wherein the support devices include left, right, and biventricular assist devices, during extracorporeal membrane oxygenation (ECMO), and cardiopulmonary bypass procedures.