Effect of Mask Dead Space and Occlusion of Mask Holes on Delivery of Nebulized Albuterol

Berlinski, Ariel

doi:10.4187/respcare.02978

Cited by 11 publications

(10 citation statements)

References 13 publications

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“…7,14 The breathing pattern with the lowest tidal volume (50 mL) had a lung dose that was lower than with the other breathing patterns (155 and 300 mL), which were similar. This could be explained by the fact that both breathing patterns had an inspiratory flow (tidal volume/inspiratory time ϫ 60) that exceeded the nebulizer flow (11.6 and 22.5 L/min, respectively).…”

Section: Discussionsupporting

confidence: 52%

Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child

Cooper

Berlinski

2015

Respir Care

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BACKGROUND: Some pediatric patients receiving therapeutic aerosols undergo tracheostomy, and others who are tracheostomized continue requiring inhaled therapies upon decannulation. It is unknown whether a dose adjustment is required. Different devices are available for facial and tracheostomy delivery, and in some instances, the assisted technique is used. We hypothesized that the change from face mask to tracheostomy would result in a decrease in the lung dose. METHODS: A breathing simulator connected in series to a filter holder and an anatomically correct head model of a child was used. The drug captured in the filter was termed the lung dose. Breathing patterns with tidal volumes of 50, 155, and 300 mL were tested. Albuterol hydrofluoroalkane (pressurized metered-dose inhaler [pMDI]) with an AeroChamber Mini (face and 4.5-mm tracheostomy), AeroTrach (4.5-mm tracheostomy), and AeroChamber (face) and albuterol (2.5 mg/3 mL) with a continuous output nebulizer (face and 4.5-mm tracheostomy) were tested. Masks were used for facial delivery. Four units of each device were tested. Particle size of the pMDI was measured by cascade impaction. Albuterol concentration was determined via spectrophotometry (276 nm). RESULTS: Switching from facial to tracheostomy delivery increased lung dose with nebulizer (all breathing patterns). When a pMDI was used, lung dose was unchanged or increased for the 50-and 155-mL and decreased for the 300-mL breathing pattern. The use of the assisted technique increased lung dose only during nebulization with the 300-mL breathing pattern. The particle size of the pMDI decreased by 19 -23% when traveling through the tracheostomy tube, which retained < 4% and < 26% of the nominal dose of a nebulizer and pMDI, respectively. CONCLUSIONS: The effect of changing the delivery route from face to tracheostomy was variable and depended on the delivery device and the breathing pattern. There is no advantage of using the assisted technique to enhance aerosol delivery.

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Section: Discussionsupporting

confidence: 52%

Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child

Cooper

Berlinski

2015

Respir Care

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“…This finding is in agreement with another study that showed that decreasing the dead space of the mask in nebulized therapy did not increase the amount of aerosol captured at the mouth opening. 19 …”

Section: Interfacesmentioning

confidence: 99%

“…[15][16][17][18] Higher tidal volumes (V T ) are associated with higher intrapulmonary deposition. 19 On the other hand, behavioral challenges are crucial in infants and young children. Crying and lack of proper mask seal are known to decrease intrapulmonary deposition.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Taoum

Kim

et al. 2015

Respir Care

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BACKGROUND: Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways. METHODS: A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm). RESULTS: Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models. CONCLUSIONS: Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.

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“…48,49 They can be instructed to switch off after a predetermined dose has been delivered and can provide operational logs regarding patient adherence to prescribed treatment. 45,47 Soft mist inhalers Continued innovation in inhaler technology has led to a new class of inhaler device called SMIs. 50 SMIs transform aqueous liquid solution to an inhalable vapour using the energy of a compressed spring inside the inhaler.…”

Section: Nebulisersmentioning

confidence: 99%

“…44 They are also useful for infants and children where the aerosol can be delivered via a facemask. 45 The most common type of nebuliser is the jet or pneumatic nebuliser, which uses compressed air to generate the aerosol. They are relatively cheap but because of their need for compressed air they can be quite bulky and noisy.…”

Section: Nebulisersmentioning

confidence: 99%

Inhaler Characteristics in Asthma

Biddiscombe¹

2017

European Respiratory &Amp; Pulmonary Diseases

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The history of inhaled therapy goes back a surprisingly long way. More than 4,000 years ago, in India, the vapour of plants from the nightshade family placed on hot bricks was inhaled to alleviate breathing difficulties. The bronchodilators, derived from these plants, and compounds related to them, have played a significant part in therapeutic aerosol delivery over the years and remain important in the treatment of lung diseases today. The development of inhaled therapy has accelerated over the past 60 years with the arrival of the first truly portable inhaler in 1956 to relieve the symptoms of asthma. Initially, only bronchodilators were delivered from these devices, but as the true nature of asthma was revealed, inhaled corticosteroids were introduced to treat the underlying inflammation that is a major component of asthma. Further advances have led to long-acting bronchodilators becoming available, and combination therapies containing both longacting bronchodilators and corticosteroids in one inhaler. Asthma therapy has come a long way in a comparatively short time with over 230 device and drug combinations available for treating the disease. However, despite enormous investment asthma remains a huge healthcare problem. The number of people with asthma continues to grow with over 300 million people affected worldwide and 250,000 annual deaths attributed to the disease. It affects people of all ages and has a varying degree of severity. In this article, we look at the ideal characteristics for asthma inhalers and highlight some of the most important reasons for the failure of current asthma treatments.

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Effect of Mask Dead Space and Occlusion of Mask Holes on Delivery of Nebulized Albuterol

Cited by 11 publications

References 13 publications

Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child

Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Inhaler Characteristics in Asthma

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