Efficiency of Bronchodilator Aerosol Delivery to the Lungs From the Metered Dose Inhaler in Mechanically Ventilated Patients

Fuller, Hugh D.; Dolovich, Myrna; Turpie, Fiona H.; Newhouse, Michael T.

doi:10.1378/chest.105.1.214

Cited by 71 publications

(63 citation statements)

References 7 publications

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“…Thus, in vitro studies indicate that 13-14% of the dose from a MDI is deposited in the lower respiratory tract when using a humidified ventilator circuit, which is greater than the value of ~6% found in the in vivo studies of FULLER and co-workers [15]. However, the latter in vivo studies did not account for tissue quenching of radioactivity [27].…”

Section: Aerosol Deposition Studies In Vivomentioning

confidence: 73%

“…5), a value significantly lower than that reported with a MDI and spacer in nonintubated ambulatory patients (~24%) [33]. In a subsequent study, FULLER and co-workers [27] compared the aerosol delivery to the lower respiratory tract in mechanically-ventilated patients with actuation of the MDI into different types of spacer devices. Values of pulmonary deposition with two chamber devices were similar and higher than those observed with an elbow adapter.…”

Section: Aerosol Deposition Studies In Vivomentioning

confidence: 87%

“…4). FULLER and co-workers [27] also reported that incorporation of a chamber type adapter in the inspiratory limb of the ventilator circuit significantly improved pulmonary deposition compared with a device that allows MDI actuation into the inspiratory limb but lacks a chamber (Instrumentation Industries Inc., Bethel Park, PA, USA). Use of an adapter connected directly to the endotracheal tube results in considerable deposition of aerosol within the tube itself, resulting in negligible therapeutic effects even after administration of very high doses from a MDI [8].…”

Section: In Vitro Modelsmentioning

confidence: 99%

See 2 more Smart Citations

Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Dhand¹,

Tobin²

1996

Eur Respir J

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Section: Aerosol Deposition Studies In Vivomentioning

confidence: 73%

Section: Aerosol Deposition Studies In Vivomentioning

confidence: 87%

Section: In Vitro Modelsmentioning

confidence: 99%

See 1 more Smart Citation

Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Dhand¹,

Tobin²

1996

Eur Respir J

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“…(18,26,27) In contrast, the efficiency of a bidirectional in-line spacer was higher than the efficiency of a unidirectional in-line spacer and it achieved comparable efficiency with chamber spacers. (28) 4.…”

Section: Factors Influencing Aerosol Delivery During Mechanical Ventimentioning

confidence: 99%

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Ari

Fink

Dhand

2012

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Incremental gains in understanding the influence of various factors on aerosol delivery in concert with technological advancements over the past 2 decades have fueled an ever burgeoning literature on aerosol therapy during mechanical ventilation. In-line use of pressurized metered-dose inhalers (pMDIs) and nebulizers is influenced by a host of factors, some of which are unique to ventilator-supported patients. This article reviews the impact of various factors on aerosol delivery with pMDIs and nebulizers, and elucidates the correlation between in-vitro estimates and in-vivo measurement of aerosol deposition in the lung. Aerosolized bronchodilator therapy with pMDIs and nebulizers is commonly employed in intensive care units (ICUs), and bronchodilators are among the most frequently used therapies in mechanically ventilated patients. The use of inhaled bronchodilators is not restricted to mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) and asthma, as they are routinely employed in other ventilator-dependent patients without confirmed airflow obstruction. The efficacy and safety of bronchodilator therapy has generated a great deal of interest in employing other inhaled therapies, such as surfactant, antibiotics, prostacyclins, diuretics, anticoagulants and mucoactive agents, among others, in attempts to improve outcomes in critically ill ICU patients receiving mechanical ventilation.

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“…[1][2][3][4][5][6][7][8] Dhand 1 reviews factors that can influence and limit aerosol delivery to the lungs during mechanical ventilation including ventilator settings, circuit design, and aerosol device selection. In general, delivery efficiency for most common administration techniques during mechanical ventilation range from 6 to 10% in vivo; however, even at these low delivery efficiencies, some aerosolized medications are shown to be clinically effective at improving lung function.…”

Section: Introductionmentioning

confidence: 99%

Improving Aerosol Drug Delivery During Invasive Mechanical Ventilation With Redesigned Components

Pw¹,

Azimi

Golshahi

et al. 2013

Respir Care

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INTRODUCTION:Patients receiving invasive mechanical ventilation with an endotracheal tube (ETT) can often benefit from pharmaceutical aerosols; however, drug delivery through the ventilator circuit is known to be very inefficient. The objective of this study was to improve the delivery of aerosol through an invasive mechanical ventilation system by redesigning circuit components using a streamlining approach. METHODS: Redesigned components were the T-connector interface between the nebulizer and ventilator line and the Y-connector leading to the ETT. The streamlining approach seeks to minimize aerosol deposition and loss by eliminating sharp changes in flow direction and tubing diameter that lead to flow disruption. Both in vitro experiments and computational fluid dynamic (CFD) simulations were applied to analyze deposition and emitted dose of drug for multiple droplet size distributions, flows, and ETT sizes used in adults. RESULTS: The experimental results demonstrated that the streamlined components improved delivery through the circuit by factors ranging from 1.3 to 1.5 compared with a commercial system for adult ETT sizes of 8 and 9 mm. The overall delivery efficiency was based on the bimodal aspect of the aerosol distributions and could not be predicted by median diameter alone. CFD results indicated a 20-fold decrease in turbulence in the junction region for the streamlined Y resulting in a maximum 9-fold decrease in droplet deposition. The relative effectiveness of the streamlined designs was found to increase with increasing particle size and increasing flow, with a maximum improvement in emitted dose of 1.9-fold. CONCLUSIONS: Streamlined components can significantly improve the delivery of pharmaceutical aerosols during mechanical ventilation based on an analysis of multiple aerosol generation devices, ETT sizes, and flows.

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Efficiency of Bronchodilator Aerosol Delivery to the Lungs From the Metered Dose Inhaler in Mechanically Ventilated Patients

Cited by 71 publications

References 7 publications

Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Improving Aerosol Drug Delivery During Invasive Mechanical Ventilation With Redesigned Components

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