Effect of pressures and type of ventilation on aerosol delivery to chronic obstructive pulmonary disease patients

Abstract

Background Continuous Positive Airway Pressure (CPAP), BiPhasic Positive Airway Pressure (BiPAP), and high flow nasal cannula (HFNC) show some evidence to have efficacy in COVID-19 patients. Delivery during noninvasive mechanical ventilation (NIV) or HFNC gives faster and more enhanced clinical effects than when aerosols are given without assisted breath. The present work aimed to compare the effect of BiPhasic Positive Airway Pressure (BiPAP) mode at two different pressures; low BiPAP (Inspiratory Positive Airway Pressure (IPAP)/Expiratory Positive Airway Pressure (EPAP) of 10/5 cm water) and high BiPAP (IPAP/EPAP of 20/5 cm water), with HFNC system on pulmonary and systemic drug delivery of salbutamol. On the first day of the experiment, all patients received 2500 μg salbutamol using Aerogen Solo vibrating mesh nebulizer. Urine samples 30 min post-dose and cumulative urinary salbutamol during the next 24 h were collected on the next day. On the third day, the ex-vivo filter was inserted before the patient to collect the delivered dose to the patient of the 2500 μg salbutamol. Salbutamol was quantified using high-performance liquid chromatography (HPLC). Results Low-pressure BiPAP showed the highest amount delivered to the lung after 30 min followed by HFNC then high-pressure BiPAP. But the significant difference was only observed between low and high-pressure BiPAP modes (p = 0.012). Low-pressure BiPAP showed the highest delivered systemic delivery amount followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.017) and high-pressure BiPAP (p = 0.008). No significant difference was reported between HFNC and high-pressure BiPAP. The ex-vivo filter was the greatest in the case of low-pressure BiPAP followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.033) and high-pressure BiPAP (p = 0.008). Also, no significant difference was found between HFNC and high-pressure BiPAP. Conclusions Our results of pulmonary, systemic, and ex-vivo drug delivery were found to be consistent. The low BiPAP delivered the highest amount followed by the HFNC then the high BiPAP with the least amount. However, no significant difference was found between HFNC and high BiPAP.

Comparison of the Application of Vibrating Mesh Nebulizer and Jet Nebulizer in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta‐analysis

“…Notably, the choice of ventilation mode (IMV vs NIV vs HFNC), the interface (facial mask vs tracheal tube), ventilation mode (pressure support vs volume-controlled ventilation), and overtime variability of respiratory drive, as well as the degree of match between patient and ventilator, may also have some influence on aerosol delivery, and more studies are still needed to provide evidence of this effect and the choice of drug dose. 46–48 …”

“…Notably, the choice of ventilation mode (IMV vs NIV vs HFNC), the interface (facial mask vs tracheal tube), ventilation mode (pressure support vs volume-controlled ventilation), and overtime variability of respiratory drive, as well as the degree of match between patient and ventilator, may also have some influence on aerosol delivery, and more studies are still needed to provide evidence of this effect and the choice of drug dose. [46][47][48] The advantages of the VMN over the JN are obvious, but clinicians are concerned that vibrating mesh nebulizers may malfunction due to clogged or blocked mesh panels, resulting in the VMN being less widely used than the JN, but a recent study has shown that despite fuzzy or partially clogged mesh panels, nebulization time, residual volume, and particle size of uncleaned vibrating mesh nebulizers remained consistent and reliable after 28 days of repetitive use. 49 In summary, with advances in medical device technology and inhaled drug administration methods, coupled with the continuous development of new compounds and the growing need for personalized approaches to managing chronic respiratory diseases, nebulizers have become valuable devices in the therapeutic hierarchy of respiratory diseases.…”

Effect of oxygen flow on aerosol delivery from a vibrating mesh nebulizer with a holding chamber

“…The only difference was that they discovered a higher oxygen flow than we did. That could be due to their use of a higher tidal volume (750 mL), which is 250 mL higher than the normal tidal volume used in most in vitro studies (500 mL) but more realistic for some adult patients [22][23][24][25][26][27][28][29][30][31][32][33], as well as their use of a valved facemask only, for which we found the best oxygen flow was 3 L/min [21], implying that the higher tidal flow improved the benefit of oxygen delivered as a supplement to the aerosol within the HC.…”

Aerosol delivery through high-flow nasal therapy: Technical issues and clinical benefits

“…In comparison with HFNC, low pressure BiPAP was more effective in the pulmonary deposition, although the difference was not significant, while the systemic deposition, and thus the risk of side effects, was significantly higher with low-pressure BIPAP. Considering the different pulmonary drug deposition, the authors suggest that dose adjustment guidelines should be developed and used when changing from one technique to another ( 35 ).…”