This study was aimed to evaluate the efficiency of a new mesh-type nebulizer for the intrapulmonary delivery of ipratropium bromide in surgical patients under mechanical ventilation. A total of 20 patients were randomly allocated to receive 0.5 mg ipratropium bromide using either a control (Pariboy SX, Pari, Co., Starnberg, Germany, n = 10) or test (NE-SM1 NEPLUS, KTMED INC., Seoul, Korea, n = 10) nebulizer during general anaesthesia. Ipratropium bromide was nebulized continuously for 20 min. in each group. Plasma concentrations of ipratropium bromide were obtained from blood samples at preset intervals. Non-compartmental analysis of ipratropium bromide was performed to compare the efficiency of pulmonary drug delivery in both nebulizers. Population pharmacokinetic analysis of ipratropium bromide was performed. Additionally, the noise level during the nebulizer operation and the aerosol particle size for each device were measured. The dose-normalized AUC last was 0.10 min/L for both nebulizers. The pharmacokinetics of nebulized ipratropium bromide can be described best by a one-compartment model with first-order absorption. The apparent volume of distribution and metabolic clearance were 1340 L and 6.78 L/min, respectively. Type of nebulizer was a significant covariate for absorption rate constant. The equivalent sound level and median aerosol particle diameter were 35.0 dB and 4.52 lm for the test nebulizer, and 60.2 dB and 3.85 lm for the control nebulizer, respectively. From the standpoint of the dose-normalized AUC last , a new vibrating mesh-type nebulizer shows similar performance in the intrapulmonary delivery of ipratropium bromide to that of a jet-type nebulizer in surgical patients.Pulmonary drug delivery is an effective route for bronchodilator administration to manage obstructive lung diseases, including asthma and chronic obstructive pulmonary disease. Nebulizers have been used to deliver bronchodilators to the lung in various clinical situations [1]. Nebulizers can be classified into two major types according to their operating principle, jet-and ultrasonic-type nebulizers [2]. For aerosol generation, jet nebulizers function via the Bernoulli principle and use high-speed velocity compressed gas, whereas ultrasonic nebulizers use a piezoelectric crystal that vibrates at a high frequency [2]. A class of advanced ultrasonic nebulizers that used ultrasonic vibrating mesh technology were launched around 2005. In these nebulizers, a mesh with 1000-7000 laser-drilled holes vibrates at the top of the liquid reservoir, and this technology is more effective than those with a vibrating piezoelectric element at the bottom of the liquid reservoir [3]. It is known that the type of nebulizer is an important factor for determining the efficiency of pulmonary drug delivery during mechanical ventilation [4]. Recently, a vibrating meshtype nebulizer (NE-SM1 NEPLUS, KTMED INC., Seoul, Korea) was commercialized and approved for the Korean market by the Korean Ministry of Food & Drug Safety. To the best of our...
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