In Vitro Evaluation of Aerosol Delivery by Different Nebulization Modes in Pediatric and Adult Mechanical Ventilators

Abstract

Albuterol samples collected in the inhalation filter, nebulizer, T-piece, and corrugated tubing were eluted with distilled water and analyzed with a spectrophotometer. RESULTS: The inhaled drug, as a percentage of total dose in both lung models, was 5.1-7.5%, without statistical significance among the 3 modes. Median nebulization times for IIM, CM, and EIM were 38.9, 14.3, and 17.7 min, respectively, and nebulization time for the 3 modes significantly differed (P < .001). The inhaled drug mass for the 3 modes with the adult lung model was similar to that with the pediatric lung model (7.39 ؎ 0.76 vs 6.27 ؎ 0.69%, P ‫؍‬ .77). CONCLUSIONS: Aerosol drug delivery with a jet nebulizer placed proximal to the ventilator was not dependent on nebulization mode during simulated pediatric and adult conventional mechanical ventilation. Use of expiratory intermittent mode and continuous nebulization should be considered to reduce treatment time.

Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

“…5 In patients receiving conventional mechanical ventilation, aerosol delivery depends on ventilation mode, tidal volume, breathing frequency, inspiratory flow humidification, nebulizer position, and type of nebulization device, and the delivery effectiveness has been reported around 10%. [15][16][17] In our study, the amount of albuterol delivered to the lung simulator varied from 0.6 to 18.4%. These data suggest that, independent of the technique used, bronchodilator delivery is a low fraction of the full dose available in the nebulizer.…”

Effect of Tidal Volume and Nebulizer Type and Position on Albuterol Delivery in a Pediatric Model of Mechanical Ventilation

“…Two other studies compared pediatric and adult models but used different size circuits, making the comparison more difficult. 5,17 Wan et al 17 compared the lung dose generated by a continuous-output jet nebulizer placed at the ventilator during different nebulization modes. The lung dose was 6.3% for the pediatric model (V T of 160 mL, breathing frequency of 25 breaths/min, inspiratory-expiratory ratio of 1:2 with a 15-mm circuit and a 5.0-mm ID ETT) and 7.4% for the adult model (V T of 600 mL, breathing frequency of 16 breaths/min, inspiratory-expiratory ratio of 1:2.5 with a 22-mm circuit and a 7.5-mm ID ETT).…”

Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers

“…(49) The use of inspiratory synchronized nebulization mode may significantly increase treatment time in mechanically ventilated patients. (50,51) In the present study, Inspi-Neb required on average 2.5 times longer time than Conti-Neb to nebulize the same nominal dose of amikacin (500 mg/4 mL), but produced a lung dose *21% greater. Pulmonary drug delivery rate, expressed as the ratio between the total daily urinary amount of amikacin and the nebulization time, was on average 1.86 times significantly higher with Conti-Neb (2.03 mg/min) than with Inspi-Neb (1.09 mg/min).…”