Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Naughton, Piers J; Joyce, Mary; Eain, Marc Mac Giolla; O’Sullivan, Andrew; MacLoughlin, Ronan

doi:10.3390/pharmaceutics13101574

Cited by 13 publications

(14 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The dose was then quantified using UV spectrophotometry (WPA Lightwave II; Biochrom Ltd.) at 276 nm and interpolation on a standard curve of serial salbutamol dilutions within a range of 3.125−100 mg/ml, and a recorded R 2 of 0.9998. The drug recovery from the filters using this method was previously reported by our group to be 100 ± 5% 17 …”

Section: Methodsmentioning

confidence: 81%

“…Nebuliser placement position is generally directed by clinical protocol or personal preference with international practice surveys suggesting little consistency in approach 28,29 . VMN itself has consistently been shown to deliver the most aerosol in models of mechanical ventilation, across adult and pediatric settings 17,30 . The dry/ventilator side is generally chosen as it is away from the patient and unlikely to be knocked over.…”

Section: Discussionmentioning

confidence: 99%

“…Here, for the first time we demonstrate that the Aerogen VMN does not influence the circuit pressures during normal operation of the pediatric ventilator, nor during the drug refill process. Previous studies in adult models have shown that pMDIs and compressed‐air driven JN result in circuit breaks, and the consequent risk of pressure loss, and escape of patient derived bioaerosols 17,34 . This maintenance of ventilator driven pressure is critical in the avoidance of conditions such as barotrauma or atelectasis in the pediatric lung.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Aerosol delivery in models of pediatric high flow nasal oxygen and mechanical ventilation

Wang

Leime

Gao

et al. 2022

Pediatric Pulmonology

Self Cite

View full text Add to dashboard Cite

Background Aerosol drug delivery during high flow nasal oxygen (HFNO) and invasive mechanical ventilation (IMV) are key respiratory care strategies available for the treatment of pediatric patients. We aimed to quantify the impact of different HFNO and IMV set‐ups on tracheal drug delivery via a vibrating mesh nebuliser (VMN). Methods Percent tracheal dose via VMN was quantified during HFNO therapy and IMV in a benchtop model of a 9‐month‐old infant. Under HFNO, 3 cannula sizes were used at 3 flow rate settings with the VMN placed at the dry side of the humidifier. Under IMV, tracheal dose when VMN was placed at the dry side of the humidifier, 15 cm from the wye and between the wye and endotracheal tube (ETT) was assessed. Salbutamol at 2.5 mg/2.5 ml (1 mg/ml) was used for each test (N = 5). The impact of VMN refill on circuit pressure under HFNO and IMV was also assessed. Results Tracheal dose was highest during HFNO with the largest cannula size (OPT318) set to the lowest flow rate setting of 2 L/min (liter per minute) (5.80 ± 0.17%). Increasing flow rate reduced tracheal drug delivery for all cannulas. For IMV, VMN on the dry side of the humidifier and between the wye and ETT gave optimal drug delivery (4.49 ± 0.14% vs. 4.43 ± 0.26% respectively). VMN refill did not impact circuit pressure for either HFNO therapy or IMV. Conclusions Gas flow rate and cannula size during HFNO and VMN position during IMV has a significant effect on tracheal drug delivery in a pediatric setting.

show abstract

Section: Methodsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aerosol delivery in models of pediatric high flow nasal oxygen and mechanical ventilation

Wang

Leime

Gao

et al. 2022

Pediatric Pulmonology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Currently, there are three prevalent aerosol generator technologies in commercial use, with many new technologies under development or as of yet not commercially available: (I) pressurized metered-dose inhalers (pMDIs); (II) dry powder inhalers; and (III) medical nebulizers [ 110 ]. The choice of device should consider the required target lung dose and the likely patient intervention at the time of administration, as both have been shown to have significant influence [ 111 , 112 ]. The pMDIs are the most prescribed device for lung diseases such as COPD and asthma, but regarding clinical research, nebulizers are the most used instrument [ 113 ].…”

Section: Pulmonary Delivery Of Stem Cell-derived Exosomesmentioning

confidence: 99%

Molecular Insight into the Therapeutic Effects of Stem Cell-Derived Exosomes in Respiratory Diseases and the Potential for Pulmonary Delivery

Azhdari

Goodarzi

Doroudian

et al. 2022

IJMS

Self Cite

View full text Add to dashboard Cite

Respiratory diseases are the cause of millions of deaths annually around the world. Despite the recent growth of our understanding of underlying mechanisms contributing to the pathogenesis of lung diseases, most therapeutic approaches are still limited to symptomatic treatments and therapies that only delay disease progression. Several clinical and preclinical studies have suggested stem cell (SC) therapy as a promising approach for treating various lung diseases. However, challenges such as the potential tumorigenicity, the low survival rate of the SCs in the recipient body, and difficulties in cell culturing and storage have limited the applicability of SC therapy. SC-derived extracellular vesicles (SC-EVs), particularly SC-derived exosomes (SC-Exos), exhibit most therapeutic properties of stem cells without their potential drawbacks. Similar to SCs, SC-Exos exhibit immunomodulatory, anti-inflammatory, and antifibrotic properties with the potential to be employed in the treatment of various inflammatory and chronic respiratory diseases. Furthermore, recent studies have demonstrated that the microRNA (miRNA) content of SC-Exos may play a crucial role in the therapeutic potential of these exosomes. Several studies have investigated the administration of SC-Exos via the pulmonary route, and techniques for SCs and SC-Exos delivery to the lungs by intratracheal instillation or inhalation have been developed. Here, we review the literature discussing the therapeutic effects of SC-Exos against respiratory diseases and advances in the pulmonary route of delivery of these exosomes to the damaged tissues.

show abstract

“…Contributing factors for reported variations in aerosol dose delivery include but are not limited to device type [1,6,[10][11][12][13][14], supplemental gas flow rates [11,[15][16][17], equipment [16], breath profiles [6,8,14], and patient interface [13,[18][19][20][21][22]. The aim of this study was to assess the impact of adult and paediatric head model choice on reported aerosol drug delivery.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Head Model Choice on the In Vitro Evaluation of Aerosol Drug Delivery

et al. 2021

Self Cite

View full text Add to dashboard Cite

There are variations in the values reported for aerosol drug delivery across in vitro experiments throughout the published literature, and often with the same devices or similar experimental setups. Factors contributing to this variability include, but are not limited to device type, equipment settings, drug type and quantification methods. This study assessed the impact of head model choice on aerosol drug delivery using six different adults and three different paediatric head models in combination with a facemask, mouthpiece, and high-flow nasal cannula. Under controlled test conditions, the quantity of drug collected varied depending on the choice of head model. Head models vary depending on a combination of structural design differences, facial features (size and structure), internal volume measurements and airway geometries and these variations result in the differences in aerosol delivery. Of the widely available head models used in this study, only three were seen to closely predict in vivo aerosol delivery performance in adults compared with published scintigraphy data. Further, this testing identified the limited utility of some head models under certain test conditions, for example, the range reported across head models was aerosol drug delivery of 2.62 ± 2.86% to 37.79 ± 1.55% when used with a facemask. For the first time, this study highlights the impact of head model choice on reported aerosol drug delivery within a laboratory setting and contributes to explaining the differences in values reported within the literature.

show abstract

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Cited by 13 publications

References 45 publications

Aerosol delivery in models of pediatric high flow nasal oxygen and mechanical ventilation

Aerosol delivery in models of pediatric high flow nasal oxygen and mechanical ventilation

Molecular Insight into the Therapeutic Effects of Stem Cell-Derived Exosomes in Respiratory Diseases and the Potential for Pulmonary Delivery

The Impact of Head Model Choice on the In Vitro Evaluation of Aerosol Drug Delivery

Contact Info

Product

Resources

About