Nebulization During Spontaneous Breathing, CPAP, and Bi-Level Positive-Pressure Ventilation: A Randomized Analysis of Pulmonary Radioaerosol Deposition

Maccari, Juçara Gasparetto; Teixeira, Cassiano; Savi, Augusto; Oliveira, Roselaine Pinheiro de; Machado, André Sant'Ana; Tonietto, Túlio Frederico; Ludwig, Eduardo; Teixeira, Paulo José Zimermann; Knorst, Marli Maria

doi:10.4187/respcare.02518

Cited by 15 publications

(11 citation statements)

References 29 publications

(40 reference statements)

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“…It was thought that this reduction in lung dose of bronchodilators using this modality of ventilation would reduce bronchodilator efficacy in relieving bronchial obstruction. In contrast, Maccari et al 31 recently reported similar lung counts after administration of a jet nebulizer with spontaneous breathing, CPAP at 10 cm H 2 O, and BPAP at 15/5 cm H 2 O. They reported counts (mean Ϯ SD) in the right lung of 196 Ϯ 167 with spontaneous breathing, 109 Ϯ 40 with CPAP, and 112 Ϯ 15 with BPAP, with a similar trend in the left lung of 225 Ϯ 293, 93 Ϯ 15, and 98 Ϯ 14, respectively.…”

Section: Discussionmentioning

confidence: 83%

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

et al. 2015

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BACKGROUND:In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are scarce in the literature. The aim of this study was to compare radioaerosol pulmonary index and radioaerosol mass balance in the different compartments (pulmonary and extrapulmonary) of radio-tagged aerosol administered using vibrating mesh nebulizers and conventional jet nebulizers during NIV. METHODS: This was a crossover clinical trial involving 10 healthy subjects (mean age of 33.7 ؎ 10.0 y) randomly assigned to both treatment arms of this study: group 1 (NIV ؉ vibrating mesh nebulizer, n ‫؍‬ 10) and group 2 (NIV ؉ jet nebulizer, n ‫؍‬ 10). All subjects inhaled 3 mL of technetium-99m diethylenetriaminepentaacetic acid (25 mCi) and 0.9% saline solution via vibrating mesh and jet nebulizers during NIV through a face mask secured with straps while receiving positive inspiratory and expiratory pressures of 12 and 5 cm H 2 O, respectively. Scintigraphy was performed to count radioaerosol particles deposited in the regions of interest to determine radioaerosol mass balance from the lungs, upper airways, stomach, nebulizer, ventilator circuit, inspiratory and expiratory filters, and mask as a percentage. RESULTS: Vibrating mesh nebulizers deposited 972,013 ؎ 214,459 counts versus jet nebulizer with 386,025 ؎ 130,363 counts (P ‫؍‬ .005). In a determination of mass balance, vibrating mesh nebulizers showed a higher deposition of inhaled radioaerosol compared with jet nebulizers (23.1 ؎ 5.8% vs 6.1 ؎ 2.5%, P ‫؍‬ .005) and a higher proportion of radioaerosol deposited into the lungs (5.5 ؎ 0.9% versus 1.5 ؎ 0.6%, respectively, P ‫؍‬ .005). The residual drug volume was lower with vibrating mesh nebulizers (5.1 ؎ 1.5%) compared with jet nebulizers (41.3 ؎ 4.2%, P ‫؍‬ .005). CONCLUSIONS: During NIV in healthy subjects, vibrating mesh nebulizers delivered > 2-fold more radiolabeled drug into the respiratory tract compared with conventional jet nebulizers. Additional studies are recommended in subjects with asthma, COPD, bronchiectasis, and cystic fibrosis to better understand differences in both aerosol delivery and response. (ClinicalTrials.gov registration NCT01889524.)

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Section: Discussionmentioning

confidence: 83%

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

et al. 2015

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“…The objective of the study by Maccari 18 et al was to determine the effect of spontaneous breathing and NIV on lung technetium-99m deposition in subjects with normal lungs. The study enrolled 13 volunteers for technetium radioaerosol nebulization during spontaneous breathing, CPAP at 10 cm H 2 O, and bi-level ventilation with inspiratory and expiratory pressures of 15 and 5 cm H 2 O.…”

Section: Healthy Volunteersmentioning

confidence: 99%

Aerosol Therapy During Noninvasive Ventilation or High-Flow Nasal Cannula

Hess

2015

Respir Care

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Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are increasingly used for patients with acute respiratory failure. Some patients receiving these therapies might also benefit from inhaled drug delivery. Thus, it is attractive to combine aerosol therapy with NIV or HFNC. The purpose of this paper is to review the available evidence related to the use of inhaled aerosols with NIV or HFNC. Available evidence supports the delivery of aerosols during NIV. Inhaled bronchodilator response might be improved with the use of NIV in acute asthma, but the evidence is not sufficiently mature to recommend this as standard therapy. Evidence does support aerosol delivery without discontinuation of NIV. Clinical studies on aerosol delivery during HFNC are needed, and based on the available in vitro evidence, it is not possible to make a recommendation for or against aerosol delivery during HFNC.

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“…Die Effektivität der Gabe von inhalativen Medikamenten während der Maskenbeatmung hängt von vielen Faktoren ab, so beeinflussen die Beatmungsdrücke, das Ausatemsystem [103] und der Ort der Applikation die Wirksamkeit [104,105]. Grundsätzlich ist bei korrektem Inhalationsmanöver die pulmonale Deposition bei Spontanatmung besser als unter NIV.…”

Section: Inhalationunclassified

S2k-Leitlinie: Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz – Revision 2017

et al. 2017

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Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010 the German Society of Pneumology and Mechanical Ventilation (DGP) has leadingly published the guidelines on "Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure". However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the guidelines.For this reason, the updated guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning.In the current guidelines different societies as well as professional and expert associations have been involved when compared to the 2010 guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved.The currently updated guidelines are valid for the next three years, following their first online publication on the home page of the Association of the Scientific Medical Societies in German (AWMF) in the beginning of July 2017. A subsequent revision of the guidelines remains the aim for the future.

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Nebulization During Spontaneous Breathing, CPAP, and Bi-Level Positive-Pressure Ventilation: A Randomized Analysis of Pulmonary Radioaerosol Deposition

Abstract: BACKGROUND: There have been few reports of factors affecting aerosol delivery during noninvasive ventilation (NIV). Nebulization is a standard practice, and our objective was to determine the effect of spontaneous breathing (SB) and NIV mode on lung technetium-99m (

Cited by 15 publications

References 29 publications

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

Aerosol Therapy During Noninvasive Ventilation or High-Flow Nasal Cannula

S2k-Leitlinie: Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz – Revision 2017

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