In Vitro Comparison of a Vibrating Mesh Nebulizer Operating in Inspiratory Synchronized and Continuous Nebulization Modes During Noninvasive Ventilation

Abstract

During simulated NIV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization improves respirable dose and reduces drug loss of amikacin compared with continuous vibrating mesh nebulization.

In vitro comparison between inspiration synchronized and continuous vibrating mesh nebulizer during trans-nasal aerosol delivery

“…Inspiration synchronized aerosol generates higher inhaled dose by reducing the waste during exhalation; this explains our findings with nebulizer placed close to patient, which agreed with the finding that higher inhaled dose with breath actuated jet nebulizer than continuous jet nebulizer when it was placed at the Y-piece during invasive ventilation [10]. Moreover, Michotte et al found higher inhaled dose with inspiration synchronized VMN than continuous VMN during noninvasive ventilation, particularly when nebulizer was placed between the single-limb ventilator and exhalation port; the waste of aerosol was more significant with continuous VMN than inspiration synchronized VMN [11]. In Golshahi et al's study, they used similar breathing parameters during quiet breathing (Vt 500 ml, RR 15) but only investigated one gas flow (20 L/min), with nebulizer placed close to patient; they also found higher inhaled dose at nostril level with inspiration synchronized than continuous aerosol [19].…”

“…Compared to the current commercially available continuous VMN, the inspiration synchronized VMN did not generate clinically relevant increment of inhaled dose, particularly at high gas flows. However, this finding was not surprising, as the inhaled dose was only slightly higher with inspiration synchronized VMN than continuous VMN in the previous in vitro and in vivo adult studies during noninvasive ventilation [11,12], while the inhaled dose was found to be even lower with inspiration synchronized VMN than continuous VMN during neonatal invasive ventilation in both in vitro and in vivo studies [23,24]. Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24].…”

“…However, this finding was not surprising, as the inhaled dose was only slightly higher with inspiration synchronized VMN than continuous VMN in the previous in vitro and in vivo adult studies during noninvasive ventilation [11,12], while the inhaled dose was found to be even lower with inspiration synchronized VMN than continuous VMN during neonatal invasive ventilation in both in vitro and in vivo studies [23,24]. Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24]. As such, the authors argued if it was worthwhile to use inspiration synchronized VMN [11,12,23,24].…”

“…Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24]. As such, the authors argued if it was worthwhile to use inspiration synchronized VMN [11,12,23,24].…”

“…The technique of synchronizing aerosol production with patient's inspiratory effort is available in small volume jet nebulizer, which shows threefold increase of inhaled aerosol mass over the conventional continuous jet nebulizer [10]. Michotte et al integrated this algorithm into VMN and compared its efficiency with continuous VMN during noninvasive ventilation; both in vitro and in vivo studies found that inspiration synchronized VMN produced higher lung dosage than continuous VMN [11,12]. However, little has been known about inspiration synchronized aerosol via HFNC.…”