Computerized Dead-Space Volume Measurement of Face Masks Applied to Simulated Faces

Amirav, Israel; Luder, Anthony; Halamish, Asaf; Marzuk, Chatib; Daitzchman, Marcelo; Newhouse, Michael T.

doi:10.4187/respcare.03813

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…The degree of adaptability and flexibility of the mask are also important factors that influence the fit and mask‐to‐face seal as well as the physical dead space of the mask . When pressed against the face, the pressure causes compression of the mask, tightening the contact and reducing the actual mask dead space . Thus, drug delivery will be affected by the force applied by the caregiver as well as the flexibility, compressibility, and shape of the mask.…”

Section: Discussionmentioning

confidence: 99%

“…32 When pressed against the face, the pressure causes compression of the mask, tightening the contact and reducing the actual mask dead space. 33,34 Thus, drug delivery will be affected by the force applied by the caregiver as well as the flexibility, compressibility, and shape of the mask. A good seal with a minimal leak around the nose, cheeks, and mouth will ensure inspiration through the VHC and not allow ingress of ambient air between the mask and face.…”

Section: Discussionmentioning

confidence: 99%

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In vitro drug delivery performance of five valved holding chambers with and without facemasks

Csonka

Lehtimäki

2019

Pediatric Pulmonology

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Background Valved holding chambers (VHCs) are essential for efficient pulmonary delivery of inhaled medication in preschool children. The numerous devices in the market vary in material, aerodynamic characteristics, volume, valve properties, and mask design. Drug delivery is affected by the VHC characteristics as well as by the age and breathing pattern of the child. Methods We measured the drug delivery efficacy of five VHCs widely available in the market, evaluated the effect of facemasks and tested the differences between manufacturing lots. A breathing simulator was used to mimic normal (respiratory rate [RR] 25/minute and tidal volume (VT) 200 mL) and obstructive (RR 50/minute and VT 50 mL) breathing of infants and toddlers. Results Salbutamol output was significantly higher with a normal breathing pattern compared to the obstructive breathing pattern in most VHCs. Without masks, the differences in the median in vitro filter doses of salbutamol were mainly from 2 to 10‐fold among different types of VHCs. With masks, there was a greater than 20‐fold difference in drug delivery capacity between the most and least effective devices. Most VHCs had a notable variation of performance between individual devices from different lots within the same brand. Conclusions There was an extreme variation in the salbutamol delivery performance among different types of VHCs for both normal and obstructive pediatric breathing patterns with and without masks. This magnitude of performance variability can have significant and unpredictable clinical implications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In vitro drug delivery performance of five valved holding chambers with and without facemasks

Csonka

Lehtimäki

2019

Pediatric Pulmonology

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“…The overall design, volume, and degree of adaptability of the face mask are important factors that influence the fit and mask-toface seal as well as the physical dead space of the mask [32]. When pressed against the face, pressure causes compression of the mask, tightening the contact and reducing the actual dead space of the mask [42,43]. However, with increasing pressure against the face, children are more likely to cry which again decreases the inhaled dose [44][45][46].…”

Section: Effect Of the Respiratory Pattern On Drug Delivery Through Vhcsmentioning

confidence: 99%

Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature

et al. 2021

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Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known:• Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI).• Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated.What is New:• The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines.• Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.

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“…Additionally, the extremely important question of mask dead space used in small children is not taken into account in regulatory conclusions. Recent studies have shown considerable differences in dead space with various masks [8]. Clearly, if the volume of the mask dead space is not taken into account and is significantly larger with one brand of mask or if greater pressure is required to achieve a seal [9], thus frightening the child, with even the best in vitro studies showing differences in aerosol delivery, the results may be clinically irrelevant!…”

mentioning

confidence: 99%

Comment on “Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers”

Newhouse

Amirav

2019

Canadian Respiratory Journal

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Computerized Dead-Space Volume Measurement of Face Masks Applied to Simulated Faces

Cited by 7 publications

References 8 publications

In vitro drug delivery performance of five valved holding chambers with and without facemasks

In vitro drug delivery performance of five valved holding chambers with and without facemasks

Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature

Comment on “Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers”

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