Albuterol delivery by metered-dose inhaler in a pediatric high-frequency oscillatory ventilation model

Garner, Sandra S.; Wiest, Donald B.; Bradley, Jana

doi:10.1097/00003246-200006000-00070

Cited by 24 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results are consisted with other experimental and numerical studies who concluded that particle deposition in a lung model would be higher under HFOV (Alzahrani 2010) and that application of HFOV would force particles to deposit on the endotrachial tube of a pressurized meter dose inhaler medical device on an overwhelming percentage (Garner et al 2000).…”

Section: Comparisonsupporting

confidence: 60%

“…Different carrier gases and different oscillating frequencies were used and the conclusion was that particle transport was faster in gases of higher kinematic viscosity and particle deposition is expected to increase with the oscillating frequency at high frequency situations (>2 Hz). Garner et al (2000) examined albuterol transfer by metered-dose inhaler in a high-frequency oscillatory ventilation model and concluded that albuterol transfer under that model would be problematic due to the high particle deposition on the endotracheal tube of the setup. Alzahrani (2010) compared albuterol delivery under HFOV, and CV by using an experimental setup with a pressurized meter dose inhaler (pMDI) and an adult cast lung model with different compliance levels.…”

Section: Particle Transport and Deposition Through Hfovmentioning

confidence: 99%

See 1 more Smart Citation

Particle Transport and Deposition under High-Frequency Oscillatory Ventilation and Normal Breathing

Makris

Pilou

Neofytou

et al. 2013

Aerosol Science and Technology

View full text Add to dashboard Cite

The fluid mechanics of high-frequency oscillatory ventilation (HFOV) for gas transport in the pulmonary region of the human lungs have been thoroughly studied by different methods. The major concept of HFOV adaptation is to push gas into further generation of the bronchial tree, with adequate gas mixing and small tidal volume. However, particle transport and deposition under HFOV is a rarely studied case where different mechanisms, compared to the mechanisms of gas transport, may associate. The target of this study is to numerically compare the efficiency of particle drug deposition under HFOV to normal breathing (NB) and to further clarify the mechanisms of particle transport and deposition under oscillating flows. A fully Eulerian computational fluid particles dynamic (CFPD) model is used for studying the transport and deposition of several sizes of inertia particles, under different transient flow conditions, inside a single physiologically realistic bifurcation created by generations G3-G4 of the human lung. An insight into the particle dynamics under high-frequency oscillating flow fields is given and the results showed that the highly oscillating field (HFOV) displayed stronger secondary flows, thinner boundary layers, and strong counter flow that accumulate and deposit particles further than a lower frequency oscillatory field (NB).

show abstract

Section: Comparisonsupporting

confidence: 60%

Section: Particle Transport and Deposition Through Hfovmentioning

confidence: 99%

Particle Transport and Deposition under High-Frequency Oscillatory Ventilation and Normal Breathing

Makris

Pilou

Neofytou

et al. 2013

Aerosol Science and Technology

View full text Add to dashboard Cite

show abstract

“…Very few studies have evaluated aerosol delivery during HFOV. Using a pressurized metered-dose inhaler with the holding chamber placed at the airway, Garner et al 22 reported negligible delivery of albuterol to a filter placed distal to the ETT. In contrast, Alzahrani et al 26 demonstrated that albuterol delivery during HFOV was significantly greater than that during conventional ventilation using an adult cast model.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, many clinicians are hesitant to administer aerosolized drugs during HFOV on the basis of a previous report that medication delivery to infants is negligible due to the small volumes, short inspiratory times, and high gas flows used with this form of ventilation. 22 We designed this in vitro study to quantify aerosol drug delivery with the hypothesis that effective levels of aerosol drug delivery could be achieved during both conventional ventilation and HFOV and that deposition efficiency would be different using a vibrating-mesh nebulizer (VMN) between each ventilator type and at two different circuit locations.…”

mentioning

confidence: 99%

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

et al. 2016

View full text Add to dashboard Cite

Iloprost is a selective pulmonary vasodilator approved for inhalation by the Food and Drug Administration. Iloprost has been increasingly used in the management of critically ill neonates with hypoxic lung disease. This in vitro study was designed to test the hypothesis that aerosol drug delivery could be effectively administered to infants with both conventional ventilation and high-frequency oscillatory ventilation (HFOV). A neonatal test lung model configured with newborn lung mechanics was ventilated with a conventional ventilator and an HFOV with standard settings. A vibrating-mesh nebulizer was placed (1) proximal to the patient airway in the inspiratory limb between the humidifier probe and patient wye (conventional) as well as between the vent circuit and the endotracheal tube (ETT) for HFOV and (2) between the ventilator and humidifier (distal). Iloprost was nebulized in three separate runs using three new nebulizers in each of the circuit locations. A collecting filter was placed at the distal end of the ETT for each trial. Iloprost was quantified using highperformance liquid chromatography. The percentage of nominal dose delivered was greater with the nebulizer placed proximal to the airway for conventional ventilation (10.74% ± 2%) and HFOV (29% ± 2%) than with it placed in the distal position (2.96% ± 0.2% vs. 0.96% ± 0.8%, respectively; P < 0.05). Drug delivery in proximal position was nearly threefold greater during HFOV than during conventional ventilation. In conclusion, iloprost drug delivery was best achieved when the nebulizer was placed proximal to the patient airway during neonatal mechanical ventilation. Drug delivery appears to be more efficient during HFOV than during conventional ventilation.Keywords: neonatal ventilation, pediatric aerosol delivery, high-frequency ventilation, inhaled pulmonary vasodilation, infant hypoxic lung disease. Iloprost (Ventavis; Actelion Pharmaceuticals US) is a stable prostacyclin analog used in the treatment of pulmonary hypertension. It is pharmacologically similar to epoprostenol, with vasodilatory, vascular remodeling, and platelet inhibitory properties, but it is a more stable compound, with an elimination half-life of 20-30 minutes. 1The longer half-life than that of other prostacyclin formulations allows the drug to be delivered with less frequency. Iloprost was the first prostacyclin designed specifically for aerosolization and approved for inhalation in ambulatory adults with primary pulmonary hypertension using the I-neb AAD system (Philips Respironics, Netherlands), a vibrating-mesh smart nebulizer. The design of the I-neb precludes its use in a closed ventilator circuit. While researchers have described a strategy for aerosol delivery during adult mechanical ventilation, none have applied such strategies for use with iloprost in infants. 2 Iloprost inhalation has been reported to be of some benefit in the management of critically ill neonates and infants with hypoxic lung disease and pulmonary hypertension.3-17 Many neonates with sever...

show abstract

“…There are relatively little published data on the efficacy and best techniques for the delivery of aerosol drugs during HFOV. Use of a metered-dose inhaler and spacer placed between the endotracheal tube and Y-connection resulted in negligible (Ͻ1%) drug delivery to a filter placed at the endotracheal tube tip (47). Use of conventional flow-driven nebulizers in the HFOV circuit will result in alterations of mPaw and ⌬P that require clinician readjustment of these variables to maintain baseline settings.…”

Section: Changes In Displayed Hfov Variables In Response To Changing mentioning

confidence: 99%

High-frequency oscillatory ventilation for acute respiratory distress syndrome in adult patients

Derdak

2003

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Albuterol delivery by metered-dose inhaler in a pediatric high-frequency oscillatory ventilation model

Abstract: These in vitro results suggest albuterol delivery by MDI in a pediatric model of HFOV is negligible, regardless of the operating frequency, inspiratory time, or use of a spacer or actuator.

Cited by 24 publications

References 19 publications

Particle Transport and Deposition under High-Frequency Oscillatory Ventilation and Normal Breathing

Particle Transport and Deposition under High-Frequency Oscillatory Ventilation and Normal Breathing

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

High-frequency oscillatory ventilation for acute respiratory distress syndrome in adult patients

Contact Info

Product

Resources

About