Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing

Ge, Huiqing; Wang, Jimei; Lin, Hui-Ling; Fink, James B.; Luo, Ronghua; Xu, Peifeng; Ying, Kejing

doi:10.1089/jamp.2018.1457

Cited by 10 publications

(11 citation statements)

References 11 publications

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“…The only significant difference is between the JN-H (0.47 ± 0.06 %/min) and the VMN-L ( P = 0.015). Previous studies have reported that the %/min of albuterol delivered by a JN was 0.52 %/min, whereas the delivery by a VMN was 2.14 %/min [23,24]. The delivery efficiency of the JN was comparable to our data; however, the delivery efficiency of the VMN-L in our study with colistin is 0.81 ± 0.20 %/min lower than that with salbutamol, as found by previous studies.…”

Section: Discussionmentioning

confidence: 99%

Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation

Liu

Fink³

et al. 2019

Pharmaceutics

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Although aerosol delivery through mechanical ventilators has been used to administer various medications, little is known of administration with colistin. This in vitro evaluation aimed to evaluate size distribution of colistin delivery by different types of nebulizers and concentrations during mechanical ventilation. Colistin methanesulfonate (colistin) for injection was dissolved in 6 mL of distilled water to produce a low concentration (L; 156 mg) and a high concentration (H; 312 mg). A dose volume of 6 mL was placed in a vibrating mesh nebulizer (VMN) and a jet nebulizer (JN). The inhaled mass (mean ± SD) of the VMN-L (53.80 ± 14.79 mg) was greater than both the JN-L (19.82 ± 3.34 mg, P = 0.001) and JN-H (31.72 ± 4.48 mg, P = 0.017). The nebulization time of the VMN-L (42.35 ± 2.30 min) was two times longer than the JN-L (21.12 ± 0.8 min) or JN-H (21.65 ± 0.42 min; P < 0.001). The mass median aerodynamic distal to the endotracheal tube was within a similar range at 2.03 to 2.26 μm (P = 0.434), independent of neb or formulation concentration. In conclusion, the VMN-L yields greater inhaled mass than the JN with either concentration. Therefore, a standard nominal dose of colistin results in a higher delivered dose during mechanical ventilation with a VMN compared with a JN and may be considered the preferred device. If JN must be used, multiple doses of low concentration colistin may compensate for poor delivery performance.

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Section: Discussionmentioning

confidence: 99%

Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation

Liu

Fink³

et al. 2019

Pharmaceutics

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“…In the current study, 5.8% respondents reported the need to increase sedation in order to improve ventilator-patient synchronization. Previous studies have shown that ventilation mode, breathing parameters, heat and humidity, gas density, and artificial airways influence aerosol delivery to critically ill subjects[12,14,30]. About 40.8% respondents reported never changing the ventilator settings during aerosol therapy; this included 33.9% and 20.8% of those who use the jet nebulizer and vibrating mesh nebulizer, respectively.…”

Section: Discussionmentioning

confidence: 99%

Practice pattern of aerosol therapy among patients undergoing mechanical ventilation in mainland China: A web-based survey involving 447 hospitals

Zhang

Fang

et al. 2019

PLoS ONE

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Background and objective Aerosol therapies are widely used for mechanically ventilated patients. However, the practice pattern of aerosol therapy in mainland China remains unknown. This study aimed to determine the current practice of aerosol therapy in mainland China. Methods A web-based survey was conducted by the China Union of Respiratory Care (CURC) from August 2018 to January 2019. The survey was disseminated via Email or WeChat to members of CURC. A questionnaire comprising 16 questions related to hospital information and 12 questions related to the practice of aerosol therapy. Latent class analysis was employed to identify the distinct classes of aerosol therapy practice. Main results A total of 693 valid questionnaires were returned by respiratory care practitioners from 447 hospitals. Most of the practitioners used aerosol therapy for both invasive mechanical ventilation (90.8%) and non-invasive mechanical ventilation (91.3%). Practitioners from tertiary care centers were more likely to use aerosol therapy compared with those from non-tertiary care centers (91.9% vs. 85.4%, respectively; p = 0.035). The most commonly used drugs for aerosol therapy were bronchodilators (64.8%) followed by mucolytic agents (44.2%), topical corticosteroids (43.4%) and antibiotics (16.5%). The ultrasonic nebulizer (48.3%) was the most commonly used followed by the jet nebulizer (39.2%), the metered dose inhaler (15.4%) and the vibrating mesh nebulizer (14.6%). Six latent classes were identified via latent class analysis. Class 1 was characterized by the aggressive use of aerosol therapy without a standard protocol, while class 3 was characterized by the absence of aerosol therapy. Conclusions Substantial heterogeneity among institutions with regard to the use of aerosol therapy was noted. The implementation of aerosol therapy during mechanical ventilation was inconsistent in light of recent practice guidelines. Additional efforts by the CURC to improve the implementation of aerosol therapy in mainland China are warranted.

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“…In a lung model, VT delivery during APRV was lower when compared to other modes (122). Spontaneous breathing during APRV results in variable VT and carries a risk of high VT delivery (123), yet aerosol deposition is increased compared to other modes (124). When compared to BiPAP with similar settings, APRV resulted in higher mPaw and higher total PEEP, and PEEP could not be predicted by lung mechanics (125).…”

Section: Bench Modelsmentioning

confidence: 93%

A narrative review of advanced ventilator modes in the pediatric intensive care unit

Miller¹,

Bartle²,

Feldman³

et al. 2021

Transl Pediatr

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Respiratory failure is a common reason for pediatric intensive care unit admission. The vast majority of children requiring mechanical ventilation can be supported with conventional mechanical ventilation (CMV) but certain cases with refractory hypoxemia or hypercapnia may require more advanced modes of ventilation. This paper discusses what we have learned about the use of advanced ventilator modes [e.g., high-frequency oscillatory ventilation (HFOV), high-frequency percussive ventilation (HFPV), high-frequency jet ventilation (HFJV) airway pressure release ventilation (APRV), and neurally adjusted ventilatory assist (NAVA)] from clinical, animal, and bench studies. The evidence supporting advanced ventilator modes is weak and consists of largely of single center case series, although a few RCTs have been performed. Animal and bench models illustrate the complexities of different modes and the challenges of applying these clinically. Some modes are proprietary to certain ventilators, are expensive, or may only be available at well-resourced centers. Future efforts should include large, multicenter observational, interventional, or adaptive design trials of different rescue modes (e.g., PROSpect trial), evaluate their use during ECMO, and should incorporate assessments through volumetric capnography, electric impedance tomography, and transpulmonary pressure measurements, along with precise reporting of ventilator parameters and physiologic variables.

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Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing

Abstract: Spontaneous breathing increased the albuterol delivery during APRV, compared with APRV alone and PCV modes. Placing the nebulizer proximal to the ventilator was more efficient for all modes tested.

Cited by 10 publications

References 11 publications

Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation

Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation

Practice pattern of aerosol therapy among patients undergoing mechanical ventilation in mainland China: A web-based survey involving 447 hospitals

A narrative review of advanced ventilator modes in the pediatric intensive care unit

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