Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Ari, Arzu

doi:10.1002/ppul.24449

Cited by 31 publications

(29 citation statements)

References 35 publications

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“…Previous in vitro and in vivo studies on aerosol delivery via HFNC all utilized unit dose with a single concentration . With unit dose administration, the inhaled dose was 10% to 15% in similar pediatric models, which was consistent with our findings using unit dose delivery.…”

Section: Discussionsupporting

confidence: 89%

“…Similar to other in vitro studies, the manikin did not simulate microstructures or complexity of human airways and use of collecting filters that do not represent aerosol exhaled in vivo, tend to overestimate inhaled dose. However, the proportional changes of inhaled dose between parameters tested should be representative.…”

Section: Discussionmentioning

confidence: 90%

“…With unit dose administration, the inhaled dose was 10% to 15% in similar pediatric models, which was consistent with our findings using unit dose delivery. Interestingly, at low administered gas flow setting (4‐5 L/min), inhaled dose in Ari's recent study that used albuterol with concentration of 2.5 mg/3 mL was only 3.27% ± 0.4%, in contrast to 13.84% ± 0.42% in Bennett et al's study, which utilized a higher concentration (2 mg/mL) with similar anatomical models and gas flow settings. Besides the slight difference between the tidal volumes (100 vs 150 mL), the low vs high concentrations in two studies may partially contribute to the different inhaled doses, which supports our finding that high‐concentrated albuterol had higher delivery efficiency than low concentration.…”

Section: Discussionmentioning

confidence: 95%

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In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Fink

2019

Pediatric Pulmonology

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Objectives Transnasal pulmonary aerosol delivery using high‐flow nasal cannula (HFNC) devices has become a popular route of aerosol administration in toddlers. Clinically, albuterol is administered using an infusion pump or unit doses. However, little evidence is available to compare the two administration strategies. Methods A toddler manikin (15 kg) with appropriate anatomic airway was connected with collecting filter to a simulator of distressed breathing. HFNC device with mesh nebulizer placed at the inlet of a humidifier at 37°C, with the gas flow set at 25 and 3.75 L/min. Five milligrams of albuterol was delivered in all experiments. With infusion pump administration, albuterol concentrations of 5 and 1 mg/mL were delivered at 4 and 20 mL/hr for 15 minutes. With unit dose administration, 1 mL (5 mg/mL) and 2 mL (2.5 mg/mL) of albuterol were nebulized. Additional tests with mouth open and nebulizers via mask were using 5 mg/1 mL for mesh nebulizer and 5 mg/3 mL for jet nebulizer (n = 3). The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results The inhaled dose was higher with unit dose than infusion pump administration with gas flows of 25 L/min (2.66 ± 0.38 vs 1.16 ± 0.28%; P = .004) and 3.75 L/min (10.51 ± 1.29 vs 8.58 ± 0.68%; P = .025). During unit dose administration, compared with closed‐mouth breathing, open‐mouth breathing generated a higher inhaled dose at 3.75 L/min and lower inhaled dose at 25 L/min. Compared to the nebulizers via mask with both open and closed‐mouth breathing, nebulization via HFNC at 3.75 L/min generated greater inhaled dose, while HFNC at 25 L/min generated lower inhaled dose. Conclusions During transnasal aerosol delivery, the inhaled dose was higher with medication administrated using unit dose than using an infusion pump.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

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In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Fink

2019

Pediatric Pulmonology

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“…Aerogen Solo is a mesh nebulizer produced by Aerogen Ltd. (Galway, Ireland). According to the current literature, this nebulizer seems to be very effective (as stated by Arzu et al, the aerosol delivery efficiency of Aerogen Solo is two to fourfold higher than in the case of the jet nebulizer [11]) and several authors mention the MMAD under 2 µm for aerosol generated by Aerogen Solo, determined by Andersen cascade impactor or the Next-generation impactor [12][13][14]. However, Gowda et al showed an issue with the continuity of nebulization and made some doubts about the reliability of the Aerogen Solo device [15].…”

Section: Introductionmentioning

confidence: 89%

Characterization of Aerosol Nebulized by Aerogen Solo Mesh Nebulizer

et al. 2020

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Nebulizers are commonly used devices for inhalation treatment of various disorders. There are three main categories of medical nebulization technology: jet nebulizers, ultrasound nebulizer, and mesh nebulizer. The mesh nebulizers seem to be very promising since this technology should be able to produce aerosol with precisely determined particle size and is easy to use as well [1]. Aerosol generated from the mesh nebulizer Aerogen Solo was measured in this work. Particle size distribution with a mass median of aerodynamic diameter (MMAD) was determined by two different methods.

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“…Additionally, the residual volume of drug remaining in nebulizers is higher in JN than VMN (45% vs 3%) [ 41 , 43 ]. Consequently, VMN generated 2–3 times higher inhaled dose than JN via HFNC for both pediatric and adult populations (Table 2 ) [ 11 , 33 , 38 , 41 ]. For these reasons, VMNs are preferred over JNs for aerosol delivery with HFNC [ 8 ].…”

Section: Factors Influencing Trans-nasal Aerosol Deliverymentioning

confidence: 99%

A narrative review on trans-nasal pulmonary aerosol delivery

Fink

MacLoughlin

et al. 2020

Crit Care

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The use of trans-nasal pulmonary aerosol delivery via high-flow nasal cannula (HFNC) has expanded in recent years. However, various factors influencing aerosol delivery in this setting have not been precisely defined, and no consensus has emerged regarding the optimal techniques for aerosol delivery with HFNC. Based on a comprehensive literature search, we reviewed studies that assessed trans-nasal pulmonary aerosol delivery with HFNC by in vitro experiments, and in vivo, by radiolabeled, pharmacokinetic and pharmacodynamic studies. In these investigations, the type of nebulizer employed and its placement, carrier gas, the relationship between gas flow and patient’s inspiratory flow, aerosol delivery strategies (intermittent unit dose vs continuous administration by infusion pump), and open vs closed mouth breathing influenced aerosol delivery. The objective of this review was to provide rational recommendations for optimizing aerosol delivery with HFNC in various clinical settings.

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Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Cited by 31 publications

References 35 publications

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Characterization of Aerosol Nebulized by Aerogen Solo Mesh Nebulizer

A narrative review on trans-nasal pulmonary aerosol delivery

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